DHA Case No. MGE 175523 (Wis. Div. of Hearings and Appeals September 27, 2016) (DHS) ↓ Download PDF Although medical assistance applicants must verify relevant information, an agency cannot deny benefits if the applicant is incapable of obtaining the verification or needs help getting it. In this case, a prior fair hearing had determined that […] Read more

DHA Case No. MGE 157892 (Wis. Div. of Hearings and Appeals July 30, 2014) (DHS) ↓ Download PDF County agencies may not over-verify; they may only require the verification needed to determine eligibility. In this case, the agency requested verification of an old family trust that had been depleted and the value of a Wispact […] Read more

DHA Case No. CWA 212224 (Wis. Div. of Hearings and Appeals July 3, 2024) (DHS) ↓ Download PDF Family Care enrollment may be backdated if agency error causes a delay in enrollment. In this case, the ADRC completed the functional screen on October 31 but did not notify IM of the referral until January 10. […] Read more

DHA Case No. MGE 212813 (Wis. Div. of Hearings and Appeals June 28, 2024) (DHS) ↓ Download PDF Family Care enrollment may be backdated if agency error causes a delay in enrollment. In this case, the agency requested verification of a new funeral trust—which the petitioner had created but not reported during the pandemic—during a […] Read more

DHA Case No. MGE 213476 (Wis. Div. of Hearings and Appeals July 8, 2024) (DHS) ↓ Download PDF The county agency must give individuals adequate written notice of verification requests. In this case, the requests “became numerous and internally inconsistent,” confusing the petitioner. ALJ Kenneth Duren concluded the agency failed to follow proper verification procedures […] Read more

DHA Case No. BCS 212166 (Wis. Div. of Hearings and Appeals May 10, 2024) (DHS) ↓ Download PDF The county agency must give individuals adequate written notice of verification requests. In this case, the agency sought to verify whether the petitioner was residing with her estranged spouse. The notice, however, only requested verification of “people […] Read more

DHA Case No. FCP 212098 (Wis. Div. of Hearings and Appeals April 26, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner claimed to have sent verification of assets being below $2,000 in December—via ACCESS and, a […] Read more

DHA Case No. MAP 212440 (Wis. Div. of Hearings and Appeals April 16, 2024) (DHS) ↓ Download PDF Applicants for Medicaid are given at least 20 days from the date of a request to provide verification, and benefits may only be denied if the applicant has the power to produce the verification. In this case, […] Read more

DHA Case No. MQB 212321 (Wis. Div. of Hearings and Appeals April 2, 2024) (DHS) ↓ Download PDF Income Maintenance agencies must assist Medicaid applicants and members with verification if asked or if they have difficulty in obtaining it. In this case, the petitioner—a 72-year old woman—faxed the required verification of her life insurance, but […] Read more

DHA Case No. MAP 211494 (Wis. Div. of Hearings and Appeals March 6, 2024) (DHS) ↓ Download PDF To be exempt homestead property, the property must serve as the individual’s primary place of residence. In this case, the petitioner owned real estate worth $25,000 and claimed he lived there in a tent, providing documents and […] Read more

DHA Case No. BCS 211320 (Wis. Div. of Hearings and Appeals January 18, 2024) (DHS) ↓ Download PDF To be eligible for Medicaid, an applicant must verify his or her income. In this case, the petitioner tried to fax the verification from a public library to two different fax numbers, but the agency never received […] Read more

DHA Case No. MGE 209717 (Wis. Div. of Hearings and Appeals January 5, 2024) (DHS) ↓ Download PDF To be eligible for SSI-related Medicaid, an unmarried individual’s countable assets must be less than $2,000. The individual must also provide the necessary verification. In this case, the petitioner received a VA lump sum payment and was […] Read more

DHA Case No. MGE 169735 (Wis. Div. of Hearings and Appeals May 3, 2016) (DHS) ↓ Download PDF Applicants for Medicaid must verify their assets, but workers cannot deny eligibility if the applicant lacks the ability to produce verification. In this case, the petitioner was incompetent and her representatives—her son and lawyer—were unable to verify […] Read more

DHA Case No. MGE 209328 (Wis. Div. of Hearings and Appeals December 5, 2023) (DHS) ↓ Download PDF An application for Institutional MA can be backdated up to three months before the month of application. The MEH provides that an application faxed and received by the agency after business hours counts as filed on the […] Read more