DHA Case No. MED 292938 (Wis. Div. of Hearings and Appeals September 3, 2008) (DHS) ↓ Download PDF Gifts received by a Medicaid recipient must be reported within ten days. In this case, the petitioner was disabled with cancer. Her community held a fundraiser and gave her almost $30,000, which she failed to report. Although […] Read more
4.4 Overpayments
DHA Case No. SSO 206537 (Wis. Div. of Hearings and Appeals January 18, 2023) (DHS) ↓ Download PDF In a fair hearing on an overpayment determination, the agency has the burden of proof. In this case, the petitioner lived in her car and drove to Arizona for the winter. She continued to receive federal SSI […] Read more
DHA Case No. SSO 209011 (Wis. Div. of Hearings and Appeals September 18, 2023) (DHS) ↓ Download PDF DHS cannot recover state SSI benefits that were incorrectly paid more than 12 months before the “date of discovery” of the overpayment. In this case, the Social Security Administration retroactively terminated the petitioner’s SSI eligibility for January […] Read more
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. MTI 207782 (Wis. Div. of Hearings and Appeals April 12, 2023) (DHS) ↓ Download PDF A party has 30 days from the date of a tax intercept notice to file an appeal; the filing date is the postmark date or the date of actual receipt by DHA, whichever is earlier. In this […] Read more
DHA Case No. MAC 206913 (Wis. Div. of Hearings and Appeals January 31, 2023) (DHS) ↓ Download PDF An Order to Compel Payment cannot be issued until the recipient has had sufficient notice of the overpayment, notice of appeal rights, and a chance to enter into a repayment agreement. In this case, the agency had […] Read more
DHA Case No. MAC 207150 (Wis. Div. of Hearings and Appeals January 31, 2023) (DHS) ↓ Download PDF To justify an Order to Compel Payment of Liability on appeal, the agency must at least show: (1) that it sent proper notice of the initial overpayment, (2) that it provided instructions for how to make payment […] 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