3.1.8 Income deductions

MGE 210319 (10/20/2023)
Funds in attorney trust account considered available

Tags: 1 Applications and Renewals, 1.2 Renewals, 3 Financial Eligibility, 3.1 Income, 3.1.8 Income deductions, 3.1.8.5 Medical and remedial expenses, 3.2 Assets, 3.2.1 Availability, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Brian C. Schneider

DHA Case No. MGE 210319 (Wis. Div. of Hearings and Appeals October 20, 2023) (DHS) ↓ Download PDF In general, all available assets are counted and counted assets are not reduced by outstanding debt. In this case, the petitioner had excess assets at her renewal and an overpayment claim that was pending but not yet […] Read more

MGE 208326 (07/18/2023)
Repayment agreement must promise periodic payments in particular amounts

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.8 Income deductions, 3.1.8.5 Medical and remedial expenses, 4 Program Administration, 4.1 Verification, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Beth Whitaker

DHA Case No. MGE 208326 (Wis. Div. of Hearings and Appeals July 18, 2023) (DHS) ↓ Download PDF Amember’s patient liability can be reduced to allow payment of medical or remedial expenses that the member “has incurred, is actually paying, and is legally obligated to pay.” In this case, after losing fair hearings on the […] Read more

CWA 208804 (09/08/2023)
Tax garnishment did not reduce patient liability

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.2 Availability, 3.1.8 Income deductions, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ John P. Tedesco

DHA Case No. CWA 208804 (Wis. Div. of Hearings and Appeals September 8, 2023) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook counts some income even though it is unavailable—garnishments, for example. In this case, the petitioner had $300 garnished monthly for a tax debt but his patient liability was not reduced to compensate. ALJ John Tedesco […] Read more

FCP 208218 (06/12/2023)
Cost share not reduced retroactively when shelter expenses reported late

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.8 Income deductions, 3.1.8.1 Maintaining home or apartment, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, 5.05.8 Groups and cost sharing, ALJ Beth Whitaker

DHA Case No. FCP 208218 (Wis. Div. of Hearings and Appeals June 12, 2023) (DHS) ↓ Download PDF Cost share reductions are effective the month of the change report, even if the actual change in income or expense was earlier. In this case, the petitioner enrolled in Family Care with a cost share effective November […] Read more

MGE 207353 DOR (06/21/2023)
Decision on remand: Repayment agreement required for medical/remedial expense

DHA Case No. MGE 207353 (Wis. Div. of Hearings and Appeals June 21, 2023) (Decision on Remand) (DHS) ↓ Download PDF Amember’s patient liability can be reduced to allow payment of medical or remedial expenses that the member “has incurred, is actually paying, and is legally obligated to pay.” In this case, the petitioner verified […] Read more

MGE 207580 (04/14/2023)
No CSIA increase, CS’s income exceeded expenses by $500+

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.8 Income deductions, 3.1.8.5 Medical and remedial expenses, 3.4 Spousal impoverishment, 3.4.6 Community spouse income allocation, 4 Program Administration, 4.7 Notices & fair hearings, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Jason M. Grace

DHA Case No. MGE 207580 (Wis. Div. of Hearings and Appeals April 14, 2023) (DHS) ↓ Download PDF An institutionalized spouse may allocate income to the community spouse up to a certain amount, and an ALJ may increase that if the petitioner shows “exceptional circumstances resulting in financial duress.” In this case, the petitioner appealed […] Read more

MGE 207353 (03/28/2023)
Repayment agreement required for medical/remedial expense

DHA Case No. MGE 207353 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF A member’s patient liability can be reduced to allow payment of medical or remedial expenses that the member “has incurred, is actually paying, and is legally obligated to pay.” In this case, the petitioner verified that he […] Read more

MGE 201844 (07/12/2021)
No income deduction for bankruptcy settlement

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.8 Income deductions, 4 Program Administration, 4.5 Undue hardship, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Kelly Cochrane

DHA Case No. MGE 201844 (Wis. Div. of Hearings and Appeals July 12, 2021) (DHS) ↓ Download PDF In determining patient liability, the Medicaid Eligibility Handbook allows a limited number of deductions from income. In this case, the petitioner could not afford to pay both his patient liability and his bankruptcy settlement. ALJ Kelly Cochrane could find […] Read more

FCP 155113 (05/14/2014)
Overnight supervision allowed as a remedial expense in calculating cost share

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.8 Income deductions, 3.1.8.5 Medical and remedial expenses, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, 5.05.8 Groups and cost sharing, ALJ Debra Bursinger

DHA Case No. FCP 155113 (Wis. Div. of Hearings and Appeals May 14, 2014) (DHS) ↓ Download PDF The issue in this case was whether overnight caregiver costs counted as a remedial expense, which could be deducted from income before determining the cost share. The agency argued these could not be a remedial expense, relying […] Read more

FCP 197076 (02/28/2020)
Cost share reduced by hardship waiver

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.5 Unearned income, 3.1.5.23 Rental income, 3.1.8 Income deductions, 3.1.8.1 Maintaining home or apartment, 4 Program Administration, 4.5 Undue hardship, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.2 Family Care Partnership, 5.05.8 Groups and cost sharing, ALJ Peter McCombs

DHA Case No. FCP 197076 (Wis. Div. Hearings and Appeals Feb. 28, 2020) (DHS) ↓ Download PDF In this case, the petitioner had a life estate in two properties, one in California and one in Wisconsin. Both were rented. But Dane County DHS did not reduce the petitioner’s cost share to allow her to pay […] Read more