DHA Case No. MDD 219941 (Wis. Div. Hearings and Appeals Dec. 10, 2025) (DHS) ↓ Download PDF If the Social Security Administration finds that a person is not disabled for social security or SSI purposes, that decision is generally binding on any state agency making a medical assistance disability determination—but there is an exception if […] Read more

DHA Case No. MAP 219997 (Wis. Div. Hearings and Appeals Oct. 31, 2025) (DHS) ↓ Download PDF An employer-sponsored retirement plan is not counted as an available asset if the individual is still working and would have to quit their job to obtain funds. In this case, the petitioner had a 401(k) with a balance […] Read more

DHA Case No. MAP 219598 (Wis. Div. Hearings and Appeals Nov. 10, 2025) (DHS) ↓ Download PDF Payment of a monthly premium is a condition of eligibility for MAPP, though a member may ask for a temporary hardship waiver that cannot exceed 12 months “for the same hardship reason.” In this case, the petitioner received […] Read more

DHA Case No. MDD 219938 (Wis. Div. Hearings and Appeals Oct. 23, 2025) (DHS) ↓ Download PDF The MAPP program allows disabled individuals to work but to retain eligibility for MA. In this case, the petitioner lost his SSI and “regular” MA when a new job put him over the substantial gainful activity limit, but […] Read more

DHA Case No. MAP 216504 (Wis. Div. Hearings and Appeals Feb. 19, 2025) (DHS) ↓ Download PDF To be eligible for MAPP, an individual must (1) be a disabled adult, (2) meet all nonfinancial Medicaid requirements, (3) satisfy the MAPP work requirement, unless exempt, and (4) pay any required premium payments, unless exempt. In this […] Read more

DHA Case No. MGE 215707 (Wis. Div. Hearings and Appeals Jan. 17, 2025) (DHS) ↓ Download PDF A person who has a cost share but fails to pay it is ineligible for Family Care. In this case, the petitioner lost eligibility for MAPP and thus had a cost share imposed. At the time of the […] Read more

DHA Case No. FCP 218179 (Wis. Div. Hearings and Appeals Jun. 16, 2025) (DHS) ↓ Download PDF Before disenrolling a member from Family Care, an MCO must give at least ten days’ notice, with the opportunity for the member to request that services be continued pending an appeal. In this case, the petitioner failed to […] 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. MAP 217949 (Wis. Div. Hearings and Appeals May 13, 2025) (DHS) ↓ Download PDF To qualify as disabled for MAPP eligibility, a person must ultimately be unable to perform any substantial gainful activity. In this case, the petitioner was 28, had autism, anxiety disorder, and mild mental retardation, and had no physical […] Read more

DHA Case No. MAP 216925 (Wis. Div. Hearings and Appeals Apr. 24, 2025) (DHS) ↓ Download PDF To be non-financially eligible for MAPP, a person must be working and meet the SSI standard for disability. In this case, the petitioner had laryngeal cancer and was initially determined disabled, but after a year and a half […] Read more

DHA Case No. MAP 214590 (Wis. Div. Hearings and Appeals Jan. 15, 2025) (DHS) ↓ Download PDF The Wisconsin Administrative Code exempts non-homestead property if it produces a reasonable amount of income, but the Medicaid Eligibility Handbook limits this exemption to $6,000. In this case, the petitioner owned a single rental home that produced at […] Read more

DHA Case No. MGE 215261 (Wis. Div. Hearings and Appeals Oct. 21, 2024) (DHS) ↓ Download PDF Community Waivers members who are eligible for any other full-benefit Medicaid program (such as MAPP) are put in Group A and have no cost share; otherwise, they are put in Group B or B Plus and do have […] 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