5.03 Medicaid Purchase Plan

MGE 209343 (10/02/2023)
Land contract and vehicle counted as available assets

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.6 Liquid assets, 3.2.6.09 Vehicles, 3.2.6.12 Land contract, 5 Subprograms, 5.03 Medicaid Purchase Plan, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, 5.09 Medicare Savings Programs, ALJ Beth Whitaker

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

FCP 206604 (01/05/2023)
Family Care cost share and MAPP eligibility flip-flopping

Tags: 5 Subprograms, 5.03 Medicaid Purchase Plan, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, 5.05.5 Fiscal test group, 5.05.8 Groups and cost sharing, ALJ Teresa A. Perez

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

MQB 209568 (10/02/2023)
Petitioner allowed to undo mistaken early renewal

Tags: 1 Applications and Renewals, 1.2 Renewals, 5 Subprograms, 5.03 Medicaid Purchase Plan, 5.09 Medicare Savings Programs, ALJ Jason M. Grace

DHA Case No. MQB 209568 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF With the Public Health Emergency unwinding, members may voluntarily complete an early renewal, but Income Maintenance agencies must inform members that their eligibility may be impacted by doing an early renewal. In this case, the member’s renewal […] Read more

MDD 207614 (04/24/2023)
MAPP disability denied, 30-yo could still perform unskilled work

Tags: 2 Nonfinancial Eligibility, 2.1 Elderly; blind; or disabled, 2.1.3 MAPP disability, 5 Subprograms, 5.03 Medicaid Purchase Plan, ALJ John P. Tedesco

DHA Case No. MDD 207614 (Wis. Div. of Hearings and Appeals April 24, 2023) (DHS) ↓ Download PDF To be eligible for the MAPP program, the applicant must meet the SSI definition of disability. This disability determination considers the applicant’s functional capacity to do various kinds of work. In this case, the applicant was 30 […] Read more

MDD 207161 (03/27/2023)
31-year-old not MAPP disabled

Tags: 2 Nonfinancial Eligibility, 2.1.1 Disability determinations, 2.1.3 MAPP disability, 5 Subprograms, 5.03 Medicaid Purchase Plan, ALJ Peter McCombs

DHA Case No. MDD 207161 (Wis. Div. of Hearings and Appeals March 27, 2023) (DHS) ↓ Download PDF A disability determination for the MAPP does not involve the usual “substantial gainful activity” test, but that is only the first step in a 5-step analysis that often comes down to “residual functional capacity” to perform different […] Read more

MDD 206834 (03/28/2023)
64-year-old with spinal problems was MAPP disabled

Tags: 2 Nonfinancial Eligibility, 2.1 Elderly; blind; or disabled, 2.1.1 Disability determinations, 2.1.3 MAPP disability, 5 Subprograms, 5.03 Medicaid Purchase Plan, ALJ John P. Tedesco

DHA Case No. MDD 206834 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF To be eligible for MAPP, an applicant must meet the SSI definition of disability. In this case, the petitioner was a 64-year-old woman with a high school diploma; diagnoses including Bipolar Disorder, ADHD, PTSD, torn rotator cuff, […] Read more

MAP 196477 (01/13/2020)
Spouse’s assets, unrecorded deed were not countable assets for MAPP

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.6 Liquid assets, 3.2.6.09 Vehicles, 3.2.7 Real property, 5 Subprograms, 5.03 Medicaid Purchase Plan, ALJ Michael D. O’Brien

DHA Case No. MAP 196477 (Wis. Div. of Hearings and Appeals January 13, 2020) (DHS) ↓ Download PDF To be eligible for the MAPP program, the individual’s countable assets must be below $15,000. Assets titled solely in a spouse’s name do not count for MAPP. In this case, the Department disenrolled the petitioner, apparently counting […] Read more

MAP 199545 (12/17/2020)
Notice of Proof Needed with inconsistent FYI section was inadequate

Tags: 4 Program Administration, 4.1 Verification, 4.7 Notices & fair hearings, 5 Subprograms, 5.03 Medicaid Purchase Plan, ALJ Debra Bursinger

DHA Case No. MAP 199545 (Wis. Div. of Hearings and Appeals December 17, 2020) (DHS) ↓ Download PDF Medicaid applicants must have adequate notice of the proof needed to verify their assets. In this case, the agency issued a Notice of Proof Needed after finding additional accounts in the Asset Verification System (AVS), but the […] Read more