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

DHA Case No. MAP 211814 (Wis. Div. of Hearings and Appeals April 8, 2024) (DHS) ↓ Download PDF A trust is not an available asset if it was funded by a third party and the Medicaid applicant or member cannot, by the terms of the trust, require the trustee to make distributions. In this case, […] Read more

DHA Case No. MAP 212141 (Wis. Div. of Hearings and Appeals March 27, 2024) (DHS) ↓ Download PDF An asset is considered unavailable if the owner documents that it will not be available for 30 days or more and a process has been started to obtain the assets. In this case, the petitioner could access […] 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

DHA Case No. MGE 209343 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF The balance of a land contract is counted as an available asset unless its terms prohibit transfer or no one is willing to purchase it. In this case, the petitioner was selling non-homestead real estate under a […] Read more

DHA Case No. FCP 206604 (Wis. Div. of Hearings and Appeals January 5, 2023) (DHS) ↓ Download PDF Family Care members in Group A (due to eligibility for MAPP, for example) do not have a cost share. In this complex case, the petitioner lost MAPP eligibility when her child turned 18 and her fiscal test […] Read more