DHA Case No. CWA 219278 (Wis. Div. Hearings and Appeals Sep. 11, 2025) (DHS) ↓ Download PDF Any negative action regarding a person enrolled in Medicaid must be preceded by proper notice. In this case, the petitioner lost her SSI eligibility but the agency never sent a notice before terminating her from IRIS. ALJ Brian […] Read more

DHA Case No. CWA 219215 (Wis. Div. Hearings and Appeals Aug. 22, 2025) (DHS) ↓ Download PDF Any negative action regarding a person enrolled in Medicaid must be preceded by proper notice that includes appeal rights. In this case, the petitioner lost her SSI eligibility but the agency never sent a notice with appeal rights […] Read more

DHA Case No. MGE 218652 (Wis. Div. Hearings and Appeals Jul. 30, 2025) (DHS) ↓ Download PDF A participant must maintain MA eligibility to remain enrolled in the Family Care program. In this case, the petitioner submitted his renewal and all verification timely, but the agency mistakenly disenrolled him. ALJ Jason Grace ordered Family Care […] Read more

DHA Case No. MGE 216321 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF An MA recipient has a right to a fair hearing when aggrieved by an action or inaction of the Department or a county when the county is acting as the agency which administers an income maintenance program. In […] Read more

DHA Case No. MLL 216729 (Wis. Div. Hearings and Appeals Apr. 21, 2025) (DHS) ↓ Download PDF When estate recovery makes a claim, Wisconsin law gives a right to appeal the issues of the value of the property and the extent of the decedent’s interest in it. In this case, the petitioner disputed the Department’s […] Read more

DHA Case No. BCS 216832 (Wis. Div. Hearings and Appeals Apr. 7, 2025) (DHS) ↓ Download PDF The agency must mail a notice of adverse action at least 10 days prior to the effective date. In this case, the petitioner never received a notice that her BadgerCare Plus renewal was due, but the agency did […] Read more

DHA Case No. FCP 216227 (Wis. Div. Hearings and Appeals Mar. 27, 2025) (DHS) ↓ Download PDF A participant in Family Care cannot be disenrolled without proper advance notice. In this case, the petitioner apparently missed a yearly renewal due in August and had difficulty navigating the re-enrollment process with the ADRC (“sometime in December […] Read more

DHA Case No. COP 216759 (Wis. Div. Hearings and Appeals Mar. 20, 2025) (DHS) ↓ Download PDF A denial of eligibility or a reduction in services for the Children’s Community Options Program is appealable to DHA, “except that lack of adequate funding may not serve as the basis.” In this case, the petitioner’s county denied […] Read more

DHA Case No. CWK 216100 (Wis. Div. Hearings and Appeals Mar. 6, 2025) (DHS) ↓ Download PDF A child in the Children’s Long-Term Support (CLTS) program must be recertified annually, including an updated functional screen. In this case, the agency tried many times to schedule a home visit with the petitioner’s mother, but she repeatedly […] Read more

DHA Case No. MGE 216346 (Wis. Div. Hearings and Appeals Feb. 28, 2025) (DHS) ↓ Download PDF An individual is financially eligible for EBD Medicaid if the total value of all non-exempt liquid assets does not exceed $2,000. In this case, the petitioner’s daughter and representative failed to complete a renewal and then, months later, […] Read more

DHA Case No. MNP 216025 (Wis. Div. Hearings and Appeals Jan. 13, 2025) (DHS) ↓ Download PDF Fair hearings allow recipients to appeal department actions that result in the denial, discontinuation, termination, suspension, or reduction of benefits. They are not for lodging complaints against providers. In this case, the petitioner filed a fair hearing that […] Read more

DHA Case No. BCS 219604 (Wis. Div. Hearings and Appeals Sep. 29, 2025) (DHS) ↓ Download PDF In this case, the petitioners filed a Marketplace application for health insurance that erroneously omitted their income. They corrected this within an hour, but not before the system sent their no-income application to the consortium for BadgerCare Plus, […] Read more

DHA Case No. MGE 218412 (Wis. Div. Hearings and Appeals Aug. 25, 2025) (DHS) ↓ Download PDF If a married applicant’s spouse refuses to cooperate with signing the Medicaid application or providing information, the applicant can request an undue hardship waiver of the application denial. That undue hardship request must describe and document “all attempts […] Read more

DHA Case No. MGE 218539 (Wis. Div. Hearings and Appeals Aug. 20, 2025) (DHS) ↓ Download PDF It is well-settled precedent that beneficiaries must be given at least 10 days advance notice prior to an adverse action, such as a reduction or termination in benefits. In this case, the petitioner lost her eligibility for SSI […] Read more