DHA Case No. MDV 38/56284 (Wis. Div. Hearings and Appeals May 6, 2003) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, the community spouse requested an increase […] Read more

DHA Case No. MRA 145788 (Wis. Div. Hearings and Appeals Apr. 5, 2013) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” The institutionalized spouse may also allocate income to children […] Read more

DHA Case No. MRA 9/41969 (Wis. Div. Hearings and Appeals Dec. 9, 1999) (DHS) ↓ Download PDF Federal law defines “institutionalized spouse” as someone who is either: (a) in a medical institution and whose spouse is not in a medical institution, or (b) receiving Community Waivers services and whose spouse is not in a medical […] Read more

DHA Case No. MRA 70/21384 (Wis. Div. Hearings and Appeals Mar. 30, 1998) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook defines a “community spouse” as someone who is both married to an institutionalized person and not living in a medical institution for 30 or more days. In this case, the petitioner resided in a […] Read more

DHA Case No. MRA 10/59183 (Wis. Div. Hearings and Appeals Sep. 23, 2003) (DHS) ↓ Download PDF At the time of this case, the Medicaid Eligibility Handbook provided that a retirement fund was not countable if the applicant was receiving periodic payments from it. “Retirement funds” included individually owned IRAs. In this case, the petitioner […] Read more

DHA Case No. MRA 20/20606 (Wis. Div. Hearings and Appeals Mar. 30, 1998) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook defines a “community spouse” as someone who is both married to an institutionalized person and not living in a medical institution for 30 or more days. In this case, the petitioner resided in a […] Read more

DHA Case No. MRA 183762 (Wis. Div. Hearings and Appeals Mar. 9, 2018) (DHS) ↓ Download PDF Wisconsin law generally provides that non-trust income is treated as the income of the “person in whose name the payment is made.” In this case, the petitioner purchased an irrevocable qualified annuity; the petitioner was the owner and […] Read more

DHA Case No. MRA 159882 (Wis. Div. Hearings and Appeals Oct. 27, 2014) (DHS) ↓ Download PDF An asset is not available if the owner documents that it will not be available for 30 days or more and a process has been started to gain access. In this case, the petitioner owned a tax-sheltered annuity […] Read more

DHA Case No. MDV 143690 (Wis. Div. Hearings and Appeals Nov. 23, 2012) (DHS) ↓ Download PDF A divestment occurs when a Medicaid applicant transfers resources and receives less than fair market value in return; exempt business assets must be used in a business “for the self-support of the individual.” In this case, the petitioner […] Read more

DHA Case No. MED 36/91877 (Wis. Div. Hearings and Appeals Jun. 4, 2008) (DHS) ↓ Download PDF An institutionalized person’s home is exempt if the person expresses an intent to return there. In this case, the petitioner was admitted to a nursing home and a doctor opined that she “cannot realistically expect to return home,” […] Read more

DHA Case No. MDV 5/105182 (Wis. Div. Hearings and Appeals 2009) (DHS) ↓ Download PDF Agift that occurred during the lookback period and was made by either the institutionalized person or his or her spouse is a divestment. In this case, the petitioner’s husband amended their revocable trust to transfer their home to a new […] Read more

DHA Case No. MDV 59/60290 (Wis. Div. Hearings and Appeals Jan. 20, 2004) (DHS) ↓ Download PDF A gift that occurred during the lookback period and was made by either the institutionalized person or his or her spouse is a divestment. In this case, the petitioner’s husband disinherited her and then died a year before […] Read more

DHA Case No. MGE 218833 (Wis. Div. Hearings and Appeals Sep. 5, 2025) (DHS) ↓ Download PDF For a single person in the Institutional MA program, the items that may be subtracted from income in determining patient liability are limited. In this case, the petitioner asked that his $70/month life insurance premiums be deducted, noting […] Read more

DHA Case No. MGE 217939 (Wis. Div. Hearings and Appeals Jul. 3, 2025) (DHS) ↓ Download PDF Aparticipant in Institutional MA may have their patient liability reduced to allow them to pay medical or remedial expenses. In this case, the petitioner owed $22,504 in unpaid patient liability due to his brother/POA’s mismanagement, or perhaps theft […] Read more