DHA Case No. MGE 213356 (Wis. Div. of Hearings and Appeals June 20, 2024) (DHS) ↓ Download PDF In this very brief—but slightly horrifying—case, Milwaukee Enrollment Services notified the petitioner that she was no longer eligible for Community Waivers because “you have asked us to stop giving you this benefit.” This was an undisputed error. […] Read more

DHA Case No. CWA 212780 (Wis. Div. of Hearings and Appeals June 10, 2024) (DHS) ↓ Download PDF When the Department reduces benefits, it has the burden of proof and must at least present a prima facie case for its decision. In this case, the agency reduced services it had previously deemed necessary and appropriate […] Read more

DHA Case No. CWA 212112 (Wis. Div. of Hearings and Appeals June 7, 2024) (DHS) ↓ Download PDF IRIS may pay for a vehicle modification as a one-time expense (OTE) request, but it must be cost-effective and all other options for funding must be exhausted first. In this case, the 20-year-old petitioner requested a $102,000 […] Read more

DHA Case No. BCS 212166 (Wis. Div. of Hearings and Appeals May 10, 2024) (DHS) ↓ Download PDF The county agency must give individuals adequate written notice of verification requests. In this case, the agency sought to verify whether the petitioner was residing with her estranged spouse. The notice, however, only requested verification of “people […] Read more

DHA Case No. FCP 212098 (Wis. Div. of Hearings and Appeals April 26, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner claimed to have sent verification of assets being below $2,000 in December—via ACCESS and, a […] Read more

DHA Case No. CWK 211734 (Wis. Div. of Hearings and Appeals April 26, 2024) (DHS) ↓ Download PDF To be eligible for the Children’s Long-Term Support program (CLTS), the child must meet an institutional level of care as determined by the program’s specific functional screen. In this case, the agency sought to disenroll the petitioner […] Read more

DHA Case No. FCP 211741 (Wis. Div. of Hearings and Appeals April 17, 2024) (DHS) ↓ Download PDF Beginning on the date of enrollment, an MCO must pay for needed services, including the continuation of current services “necessary to ensure health and safety and continuity of care,” until the full assessment and member-centered plan are […] Read more

DHA Case No. MAP 212440 (Wis. Div. of Hearings and Appeals April 16, 2024) (DHS) ↓ Download PDF Applicants for Medicaid are given at least 20 days from the date of a request to provide verification, and benefits may only be denied if the applicant has the power to produce the verification. In this case, […] Read more

DHA Case No. MQB 212321 (Wis. Div. of Hearings and Appeals April 2, 2024) (DHS) ↓ Download PDF Income Maintenance agencies must assist Medicaid applicants and members with verification if asked or if they have difficulty in obtaining it. In this case, the petitioner—a 72-year old woman—faxed the required verification of her life insurance, but […] Read more

DHA Case No. FCP 211940 (Wis. Div. of Hearings and Appeals March 19, 2024) (DHS) ↓ Download PDF In general, all Family Care services must be authorized before they are provided. In this case, the petitioner’s assisted living facility closed and he had to move to a new one. My Choice staff met with him […] Read more

DHA Case No. MLL 211983 (Wis. Div. of Hearings and Appeals March 18, 2024) (DHS) ↓ Download PDF A hardship waiver for estate recovery must be mailed within 45 days of the notice from DHS. In this tragic case, the waiver was due December 25. The petitioner called Estate Recovery on December 18 to ask […] Read more

DHA Case No. CWK 210726 (Wis. Div. of Hearings and Appeals March 15, 2024) (DHS) ↓ Download PDF Individual choice of provider is a main tenet of the CLTS program. Even when a background check on a proposed provider reveals negative—but not disqualifying—findings, the County Waiver Agency must respect the participant’s choice “unless there is […] Read more

DHA Case No. MNP 211393 (Wis. Div. of Hearings and Appeals March 8, 2024) (DHS) ↓ Download PDF Wisconsin Medicaid covers emergency out-of-state services, even if the provider is not certified with Wisconsin Medicaid. In this case, the petitioner had a seizure while in Florida with her family and was transported by ambulance. The ambulance […] Read more

DHA Case No. MAP 211494 (Wis. Div. of Hearings and Appeals March 6, 2024) (DHS) ↓ Download PDF To be exempt homestead property, the property must serve as the individual’s primary place of residence. In this case, the petitioner owned real estate worth $25,000 and claimed he lived there in a tent, providing documents and […] Read more