DHA Case No. MDV 5/105182 (Wis. Div. Hearings and Appeals 2009) (DHS) ↓ Download PDF Agift that occurred during the lookback period and was made by either the institutionalized person or his or her spouse is a divestment. In this case, the petitioner’s husband amended their revocable trust to transfer their home to a new […] Read more
Tag: 4.7 Notices & fair hearings
DHA Case No. FCP 220016 (Wis. Div. Hearings and Appeals Dec. 8, 2025) (DHS) ↓ Download PDF Medicaid appeals must be filed within 45 days of the date of the notice of action. In this case, the petitioner was sent a cost share notice on April 11 but did not file an appeal until September […] Read more
DHA Case No. HMO 220155 (Wis. Div. Hearings and Appeals Dec. 26, 2025) (DHS) ↓ Download PDF Wisconsin Medicaid does not cover experimental services, a determination the Department makes on its own. In this case, the petitioner requested an Occipital Nerve Block, which was denied as experimental. While recognizing that past decisions have considered experimental […] Read more
DHA Case No. CWK 219225 (Wis. Div. Hearings and Appeals Dec. 26, 2025) (DHS) ↓ Download PDF For the Children’s Community Options Program, the right to appeal is limited to the denial of eligibility for services, or a reduction or termination of services. In this case, the petitioner requested coverage of a safety wagon. ALJ […] Read more
DHA Case No. CWA 220073 (Wis. Div. Hearings and Appeals Dec. 5, 2025) (DHS) ↓ Download PDF When the IRIS program ends a participant’s enrollment involuntarily, it bears the burden of proof to show that the disenrollment was proper. In this case, the IRIS Consultant (IC) submitted only an unsigned, unsworn written statement about an […] Read more
DHA Case No. BCS 219426 (Wis. Div. Hearings and Appeals Oct. 15, 2025) (DHS) ↓ Download PDF Medicaid recipients are entitled to at least 10 days’ notice before any adverse action. In this case, the petitioner failed to provide verification due August 4, so on August 5 the agency issued a notice terminating benefits as […] Read more
DHA Case No. CWK 219831 (Wis. Div. Hearings and Appeals Nov. 20, 2025) (DHS) ↓ Download PDF CLTS policy requires advance notice of any adverse action at least 15 days before the effective date. In this case, the petitioner was found functionally ineligible and the notice was sent by the county only six days before […] Read more
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
COP 216759 (03/20/2025)
No right to appeal denial of funding in Children’s Community Options Program
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