DHA Case No. FCP 173457 (Wis. Div. of Hearings and Appeals September 15, 2016) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook used to direct that the snapshot date for a spousal asset assessment was the “date of the first request for Community Waivers.” In this case, the petitioner was determined functionally eligible on August […] Read more

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

DHA Case No. MGE 207300 (Wis. Div. of Hearings and Appeals February 28, 2023) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, the community spouse had earned […] Read more

DHA Case No. MRA 207266 (Wis. Div. of Hearings and Appeals April 27, 2023) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, ALJ Jason Grace increased the […] Read more

DHA Case No. MGE 194293 (Wis. Div. of Hearings and Appeals January 6, 2020) (DHS) ↓ Download PDF The amount a community spouse can keep depends on the couple’s total resources on the date of the asset assessment, which is often the date a functional screen was completed and the person was determined functionally eligible. […] Read more

DHA Case No. MGE 197359 (Wis. Div. of Hearings and Appeals March 4, 2020) (DHS) ↓ Download PDF A community spouse must sign the Medicaid application and verify his or her assets unless a denial would result in undue hardship. In this case, the petitioner moved to a separate home from his wife in the […] Read more

DHA Case No. MGE 208717 (Wis. Div. of Hearings and Appeals July 20, 2023) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook contains two competing rules: revocable annuities are countable and available assets, but IRAs belonging to a community spouse are disregarded. In this case, the community spouse owned two Individual Retirement Annuities. The agency argued these […] Read more

DHA Case No. MGE 197217 (Wis. Div. of Hearings and Appeals May 21, 2020) (DHS) ↓ Download PDF The usual maximum for the Community Spouse Income Allocation (CSIA) can be increased by an ALJ if needed to pay for “necessary and basic” expenses. In this case, ALJ John Tedesco increased the CSIA to $4,078, largely […] Read more

DHA Case No. MGE 202884 (Wis. Div. of Hearings and Appeals November 2, 2021) (DHS) ↓ Download PDF In a spousal impoverishment case, the most valuable vehicle is exempted and all others are counted. In this case, the petitioner’s attorney argued (among other things) that he could elect to exempt the least valuable vehicle for the asset […] Read more

DHA Case No. MRA 205971 (Wis. Div. of Hearings and Appeals October 17, 2022) (DHS) ↓ Download PDF An ALJ may increase the Community Spouse Income Allowance (CSIA) if either spouse proves exceptional circumstances resulting in financial duress. In this case, although the community spouse had $3,858.22 of her own income, she also had monthly […] Read more

DHA Case No. MRA 178406 (Wis. Div. of Hearings and Appeals January 13, 2017) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook contains two competing rules: revocable annuities are countable and available assets, but IRAs belonging to a community spouse are disregarded. In this case, the community spouse owned an Individual Retirement Annuity, funded by […] Read more

DHA Case No. MED-40/46891 (Wis. Div. of Hearings and Appeals March 29, 2001) (DHS)  ↓ Download PDF In a spousal impoverishment case, the Wisconsin administrative code provides that funds “expressly set aside” for burial expenses are not countable. In this case, the petitioner’s attorney told the county agency, in writing, that $3,000 in a certain […] Read more

DHA Case No. MRA 135337 (Wis. Div. of Hearings and Appeals Feb. 10, 2012) (DHS)  ↓ Download PDF The Medicaid Eligibility Handbook contains two apparently conflicting rules. On the one hand, revocable annuities are counted as available assets. On the other hand, the retirement accounts of a community spouse are exempt. In this case, the […] Read more

DHA Case No. MRA-70/110322 (Wis. Div. of Hearings and Appeals May 19, 2010) (DHS)  ↓ Download PDF This case is an example of using the fair hearing process to increase the Community Spouse Resource Allowance (CSRA) beyond the normal limits. At the time of this case, the maximum CSRA would have been something like $110,000. […] Read more