3 Financial Eligibility

DHA Case No. MDV 208396 (Wis. Div. of Hearings and Appeals June 29, 2023) (DHS) ↓ Download PDF Any transfer of resources for less than fair market value is generally a divestment, but there is an exception if the resource was transferred “exclusively for some other purpose than to become eligible for MA.” In this […] Read more

DHA Case No. MDV 208757 (Wis. Div. of Hearings and Appeals July 27, 2023) (DHS) ↓ Download PDF To waive the entire divestment penalty, an undue hardship waiver request must be filed within 20 days of the undue hardship notice letter mailed by the agency. If filed later, the earliest effective date is the date […] Read more

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

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

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

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 203793 (Wis. Div. of Hearings and Appeals December 23, 2021) (DHS) ↓ Download PDF Income is not counted as a resource in the month it is received. In this case, the petitioner had income of $3,660.10, but his checking account balance at the end of the month was only $983.80. The […] Read more

DHA Case No. BCS 207099 (Wis. Div. of Hearings and Appeals February 20, 2023) (DHS) ↓ Download PDF Countable self-employment income is generally reduced by business expenses, but “principal payments on loans for the purchase price of income-producing real estate, capital assets and equipment, and durable goods” are not allowed expenses for BadgerCare Plus and Medicaid. In […] 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 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

DHA Case No. BCS 207395 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF A Notice of Proof Needed must advise the applicant of the specific verification required. In this case, the petitioner received a notice requesting proof of “TUITION: Amount of student loan or grant funds and how they are […] 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. MDV 207202 (Wis. Div. of Hearings and Appeals February 23, 2023) (DHS) ↓ Download PDF A transfer for less than fair market value is a divestment, and payments to relatives often also need a notarized contract or lease. In this case, the petitioner’s son and POA used the proceeds from selling her […] Read more