DHA Case No. MGE 215302 (Wis. Div. Hearings and Appeals Jun. 2, 2025) (DHS) ↓ Download PDF The agency is required to verify income, assets, and divestments, both at application and at renewals. The applicant or member has the primary responsibility to provide verification and resolve questionable information. In this case, the petitioner’s authorized representatives […] Read more

DHA Case No. CWA 216813 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF The IRIS waiver requires IRIS Consultant Agencies (ICAs) to monitor participants’ health and safety, address health and safety concerns with the participant, and ultimately disenroll participants when health and safety concerns remain despite remediation efforts. In this case, […] Read more

DHA Case No. CWA 217415 (Wis. Div. Hearings and Appeals May 5, 2025) (DHS) ↓ Download PDF The Department may disenroll IRIS participants if it cannot develop a plan that ensures the participant’s health and safety. In this case, the petitioner’s behavior support plan—staff call 911 and seek refuge in their cars if he gets […] Read more

DHA Case No. MLL 216316 (Wis. Div. Hearings and Appeals Mar. 6, 2025) (DHS) ↓ Download PDF Serving as a caretaker child does not justify a hardship waiver of estate recovery. In this case, the petitioner took care of her father and mother for years in their home, but the home was never transferred to […] Read more

DHA Case No. MGE 216012 (Wis. Div. Hearings and Appeals Feb. 18, 2025) (DHS) ↓ Download PDF A notice is not adequate if it does not expressly identify the program for which benefits are denied. Also, an application cannot be denied merely because the applicant lacks the power to produce verification. In this case, the […] Read more

DHA Case No. MQB 216374 (Wis. Div. Hearings and Appeals Feb. 10, 2025) (DHS) ↓ Download PDF The SLMB+ Medicare savings program has higher income limits but is only available to those not enrolled in a full-benefit Medicaid program, such as MAPP. In this case, the petitioner was initially enrolled in MAPP and therefore not […] Read more

DHA Case No. MAP 216062 (Wis. Div. Hearings and Appeals Feb. 4, 2025) (DHS) ↓ Download PDF The agency may not require one particular type of verification when various types are adequate and available. In this case, the petitioner owned a newly incorporated business with no previous tax filings. Instead of submitting a self-employment income […] Read more

DHA Case No. CWA 215899 (Wis. Div. Hearings and Appeals Jan. 30, 2025) (DHS) ↓ Download PDF An appeal of an adverse benefit determination by an MCO must generally be filed within 90 days. Additionally, issues that have been decided in a previous appeal are precluded. In this case, the petitioner faxed her appeal of […] Read more

DHA Case No. FCP 215537 (Wis. Div. Hearings and Appeals Jan. 24, 2025) (DHS) ↓ Download PDF Family Care services must generally be from appropriate and qualified providers, be fair and safe, serve to maintain community connections, and be cost effective. In this sympathetic case, the petitioner—a competent 43-year-old man with muscular dystrophy, severe respiratory […] Read more

DHA Case No. CWA 215921 (Wis. Div. Hearings and Appeals Jan. 22, 2025) (DHS) ↓ Download PDF Providers are generally not allowed to restrain MA participants, but this rule can be waived after an application to the Department. In this case, the petitioner had a waiver that expired June 21, 2024. Although his mother reapplied […] Read more

DHA Case No. MGE 215615 (Wis. Div. Hearings and Appeals Jan. 6, 2025) (DHS) ↓ Download PDF To pay a relative for services in amounts exceeding 10% of the maximum Community Spouse Asset Share requires a written, notarized contract at the time the services were provided. In this case, petitioners were a married couple, both […] Read more

DHA Case No. MDV 137218 (Wis. Div. Hearings and Appeals Feb. 7, 2012) (DHS) ↓ Download PDF When an institutionalized person fails to claim his or her share of a deceased spouse’s estate, it is generally a divestment. In this case, the petitioner’s wife created a revocable trust after his enrollment that included no share […] Read more

DHA Case No. MDV 149517 (Wis. Div. Hearings and Appeals Jul. 26, 2013) (DHS) ↓ Download PDF Money spent for fair market value is generally not a divestment, but the agency may require verification of large cash withdrawals. In this case, the petitioner’s daughter attempted to verify $22,219.40 in cash withdrawals with a spreadsheet. ALJ […] Read more

DHA Case No. MDV 147776 (Wis. Div. Hearings and Appeals Jul. 12, 2013) (DHS) ↓ Download PDF The divestment penalty period for an Institutional MA applicant begins on the first date the person (1) is institutionalized, (2) has applied for Medicaid, and (3) is otherwise eligible for Medicaid. In this case, the petitioner applied on […] Read more