DHA Case No. BCS 215656 (Wis. Div. Hearings and Appeals Dec. 27, 2024) (DHS) ↓ Download PDF A notice requesting verification must be in writing, specific as to the verification required, and allow a minimum of 20 days to provide it. A notice of adverse action must be mailed at least 10 calendar days before […] Read more

DHA Case No. BCS 215161 (Wis. Div. Hearings and Appeals Dec. 18, 2024) (DHS) ↓ Download PDF To be eligible for BadgerCare Plus, a person must meet certain financial and non-financial requirements, including verification of income for self-employment. In this case, the petitioner verified her self-employment income with a partial, unsigned copy of her tax […] Read more

DHA Case No. CWA 215956 (Wis. Div. Hearings and Appeals Feb. 28, 2025) (DHS) ↓ Download PDF To be approved as part of an IRIS budget, services must generally be cost-effective. In this case, the petitioner requested a budget amendment to pay $30 and $35 per hour for Supportive Home Care (SHC) services. The agency […] Read more

DHA Case No. CWA 215403 (Wis. Div. Hearings and Appeals Feb. 5, 2025) (DHS) ↓ Download PDF The IRIS program can pay for residential services, such as those provided in an adult family home (AFH), but “residential services” does not include the cost of room and board. In this case, the petitioner asked to increase […] Read more

DHA Case No. MGE 215845 (Wis. Div. Hearings and Appeals Feb. 17, 2025) (DHS) ↓ Download PDF Medicaid denials must be appealed within 45 days. In this case, the petitioner received notices dated April 18, 2023 and August 29, 2023 determining that she was over the asset limit in April, May, and June. But because […] Read more

DHA Case No. MGE 208717 (Wis. Div. Hearings and Appeals Nov. 26, 2024) (DHS) (decision on cost motion) ↓ Download PDF Under the Wisconsin Equal Access to Justice Act (WEAJA), petitioners who prevail in a fair hearing are entitled to an award of costs unless the agency’s action was “substantially justified.” In this case, the […] Read more

DHA Case No. CWA 212613 (Wis. Div. Hearings and Appeals May 30, 2024) (DHS) ↓ Download PDF IRIS participants must pay their providers a “usual and customary rate.” In this case, the petitioner’s supported employment provided asked for a rate increase to maintain a competitive wage for employees and pay for rising health insurance, mileage, […] Read more

DHA Case No. CWA 212824 (Wis. Div. Hearings and Appeals Jun. 26, 2024) (DHS) ↓ Download PDF The Department may deny an IRIS budget amendment (BA) request if it is not cost-effective or necessary to achieve the participant’s long-term care outcomes. In this case, the petitioner sought a BA to fund a 4% increase in […] Read more

DHA Case No. CWA 212682 (Wis. Div. Hearings and Appeals Jul. 12, 2024) (DHS) ↓ Download PDF Customized goods or services under the IRIS program must generally be necessary and cost-effective. In this case, the petitioner already had one trained service dog (the training was approved in a prior appeal) but wanted IRIS to pay […] Read more

DHA Case No. CWK 212876 (Wis. Div. Hearings and Appeals Jul. 15, 2024) (DHS) ↓ Download PDF The CLTS program covers home modifications that maximize a participant’s independent functioning in their home. In this case, the petitioner was an autistic child with destructive behaviors. His mother requested durable, solid-wood kitchen cabinetry because he would break […] Read more

DHA Case No. CWK 213060 (Wis. Div. Hearings and Appeals Jul. 15, 2024) (DHS) ↓ Download PDF The parent or caretaker of a CLTS participant may have respite services provided in another’s home if the length of stay is 72 hours or less, even if background checks cannot be completed on all the residents in […] Read more

DHA Case No. 212756 (Wis. Div. Hearings and Appeals Aug. 19, 2024) (DHS) ↓ Download PDF To be approved, IRIS home modifications must address long-term care needs that increase independence; or ensure safe, accessible means of ingress/egress to living quarters; or “otherwise provide safe access to rooms, facilities or equipment within the participant’s living quarters.” […] Read more

DHA Case No. CWK 213700 (Wis. Div. Hearings and Appeals Aug. 30, 2024) (DHS) ↓ Download PDF Educational services funded by the Department of Public Instruction cannot also be covered under CLTS’ “Empowerment and Self-Determination Supports” service code. In this case, the petitioner was initially approved to see a one-on-one provider for help with functional […] Read more

DHA Case No. CWA 214423 (Wis. Div. Hearings and Appeals Nov. 6, 2024) (DHS) ↓ Download PDF IRIS funds may only be used for services, supports, or goods that address a long-term support need. In this case, the petitioner asked IRIS to pay for his participant-hired worker’s travel and lodging costs so he could attend […] Read more