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. FCP 219488 (Wis. Div. Hearings and Appeals Nov. 4, 2025) (DHS) ↓ Download PDF To be covered under Family Care, a service must be cost-effective. In this case, the MCO denied the petitioner’s request for 24/7 supportive home care (SHC), claiming it would be more cost-effective for him to move to a […] Read more

DHA Case No. CWA 218110 (Wis. Div. Hearings and Appeals Sep. 25, 2025) (DHS) ↓ Download PDF IRIS participants may submit one-time expense requests to pay for goods or services, including adaptive aids such as vehicle modifications. In this case, the petitioner requested a wheelchair and hand-controls conversion after her old vehicle, which had been […] Read more

DHA Case No. CWA 218438 (Wis. Div. Hearings and Appeals Sep. 18, 2025) (DHS) ↓ Download PDF Prevocational services may be funded through IRIS, but services in sheltered workshop settings are excluded and the participant must have a goal of community-integrated employment. In this case, the petitioner received prevocational services for 11 years in a […] 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. FCP 218531 (Wis. Div. Hearings and Appeals Sep. 4, 2025) (DHS) ↓ Download PDF The Family Care program must generally cover services that reasonably and effectively address the participant’s long-term needs, but those services must also be cost-effective. In this case, the agency denied the petitioner’s request for coverage of a health […] Read more

DHA Case No. FCP 219093 (Wis. Div. Hearings and Appeals Aug. 25, 2025) (DHS) ↓ Download PDF The Family Care program must generally cover services that reasonably and effectively address the participant’s long-term needs, but those services must also be cost-effective. In this case, the petitioner’s home-delivered meals ended because his plan already included Supportive […] 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. CWA 218425 (Wis. Div. Hearings and Appeals Aug. 11, 2025) (DHS) ↓ Download PDF Prevocational services may be funded through IRIS, but the participant must have a goal of community-integrated employment. In this case, the petitioner received prevocational services for three years as part of his IRIS budget (and it appears he […] 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. CWA 217841 (Wis. Div. Hearings and Appeals Jun. 27, 2025) (DHS) ↓ Download PDF IRIS participants may submit one-time expense requests to pay for goods or services, including adaptive aids such as vehicle modifications. In this case, the petitioner requested a wheelchair conversion for a new SUV, which TMG denied as not […] Read more

DHA Case No. CWK 218183 (Wis. Div. Hearings and Appeals Jun. 17, 2025) (DHS) ↓ Download PDF The Children’s Long-Term Support Program (CLTS) can cover health and wellness activities, but services generally cannot be duplicative and payments cannot be made directly to the participant or to another person on behalf of the participant. In this […] Read more

DHA Case No. FCP 217858 (Wis. Div. Hearings and Appeals Jun. 2, 2025) (DHS) ↓ Download PDF An individual in the Family Care program must have an Individual Service Plan (ISP) that reasonably and effectively addresses their needs but is also cost-effective. In this case, the petitioner’s MCO (Inclusa) ended coverage of an independent nurse—who […] Read more

DHA Case No. CWA 216919 (Wis. Div. Hearings and Appeals May 30, 2025) (DHS) ↓ Download PDF An IRIS participant’s budget is based in their long-term care functional screen. In this case, the petitioner’s Supportive Home Care (SHC) hours were reduced from 22.25 to 5 hour per week, even though his most recent functional screen […] Read more