4.4 Overpayments

DHA Case No. MOP 190168 (Wis. Div. of Hearings and Appeals January 11, 2019) (DHS) ↓ Download PDF When a Medicaid recipient fails to report a change in income or assets that would affect eligibility, an overpayment results. In this case, the petitioner was a 92-year-old woman receiving community waivers and healthcare benefits, and it […] Read more

DHA Case No. MDV 193440 (Wis. Div. of Hearings and Appeals June 11, 2019) (DHS) ↓ Download PDF A land contract must have a term within the lender’s life expectancy, provide for equal payments, and not allow cancellation on the death of the lender to avoid being considered a divestment. If it does not meet […] Read more

DHA Case No. MAC 208599 (Wis. Div. of Hearings and Appeals July 19, 2023) (DHS) ↓ Download PDF A Medicaid appeal must be filed with the Division of Hearings and Appeals, not a different agency, by the deadline. In this case, the petitioner apparently mailed his appeal to the county agency (i.e., DHS) rather than […] Read more

DHA Case No. MTI 208493 (Wis. Div. of Hearings and Appeals July 14, 2023) (DHS) ↓ Download PDF To be recoverable, an overpayment must be caused by the recipient’s error—overpayments caused by agency error are not recoverable. In this case, the petitioner misread a notice of FoodShare benefits ending, believing all her benefits were ending. In fact, […] Read more

DHA Case No. SSO 208238 (Wis. Div. of Hearings and Appeals June 22, 2023) (DHS) ↓ Download PDF Wisconsin pays a state supplement to SSI recipients who are Wisconsin residents. In this case, the state SSI office claimed an overpayment because the Social Security Administration coded the petitioner as a California resident from December 2021 […] Read more

DHA Case No. MAC 206795 (Wis. Div. of Hearings and Appeals February 8, 2023) (DHS) ↓ Download PDF To prevail at an appeal regarding an Order to Compel Payment of MA/BCP Liability, the agency must show, to begin with, that it provided proper notice of the underlying overpayment. Proper notice must include both the right […] Read more

DHA Case No. MOP 197486 (Wis. Div. of Hearings and Appeals February 27, 2020) (DHS) ↓ Download PDF To establish an overpayment, the Department has the burden of proof by the preponderance of the evidence. In this case, the issue was whether the petitioner’s husband lived with her or not (if so, her household income […] 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. 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. 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