DHA Case No. MRA 216768 (Wis. Div. Hearings and Appeals Mar. 6, 2025) (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, a previous fair hearing decision had […] Read more

DHA Case No. MGE 216362 (Wis. Div. Hearings and Appeals Mar. 4, 2025) (DHS) ↓ Download PDF An individual is financially eligible for EBD Medicaid if the total value of all non-exempt liquid assets does not exceed $2,000 at the end of the month. In this case, the petitioner owned countable assets of $2,015.27 as […] Read more

DHA Case No. MGE 216346 (Wis. Div. Hearings and Appeals Feb. 28, 2025) (DHS) ↓ Download PDF An individual is financially eligible for EBD Medicaid if the total value of all non-exempt liquid assets does not exceed $2,000. In this case, the petitioner’s daughter and representative failed to complete a renewal and then, months later, […] Read more

DHA Case No. MDV 218743 (Wis. Div. Hearings and Appeals Oct. 22, 2025) (DHS) ↓ Download PDF A refusal to claim property of a deceased spouse that a Medicaid applicant or member is entitled to is a divestment. In this case, the petitioner’s husband used nearly all the money in a joint revocable trust to […] Read more

DHA Case No. MGE 218412 (Wis. Div. Hearings and Appeals Aug. 25, 2025) (DHS) ↓ Download PDF If a married applicant’s spouse refuses to cooperate with signing the Medicaid application or providing information, the applicant can request an undue hardship waiver of the application denial. That undue hardship request must describe and document “all attempts […] Read more

DHA Case No. MGE 218599 (Wis. Div. Hearings and Appeals Aug. 15, 2025) (DHS) ↓ Download PDF An individual is financially eligible for EBD Medicaid if the total value of all countable and available resources does not exceed $2,000 at the end of the month in question. Income received that month and checks delivered but […] Read more

DHA Case No. MGE 218218 (Wis. Div. Hearings and Appeals Aug. 6, 2025) (DHS) ↓ Download PDF An ALJ can increase the Community Spouse Resource Allowance (CSRA) if the additional resources are needed to generate income for the community spouse up to the Minimum Monthly Maintenance Needs Allowance (MMMNA). In this case, the petitioner and […] Read more

DHA Case No. MDV 217177 (Wis. Div. Hearings and Appeals Jul. 11, 2025) (DHS) ↓ Download PDF Medicaid fair hearing appeals must be filed within 45 days of the negative action. In this case, the incapacitated, nursing-home-bound petitioner—really, those acting on his behalf—went through a long period of multiple applications and denials. At first the […] Read more

DHA Case No. MNP 218271 (Wis. Div. Hearings and Appeals Jul. 21, 2025) (DHS) ↓ Download PDF A valid notice must be sent at least 10 days before the adverse action and provide information about the right to appeal, including the right to continue benefits while the appeal is pending. In this case, the petitioner […] Read more

DHA Case No. MGE 216988 (Wis. Div. Hearings and Appeals Jul. 14, 2025) (DHS) ↓ Download PDF The transfer of resources for less than fair market value is a divestment resulting in a penalty period. The penalty (for Institutional MA) begins the first date the applicant applied and would have been otherwise eligible. In this […] Read more

DHA Case No. MGE 217686 (Wis. Div. Hearings and Appeals Jun. 17, 2025) (DHS) ↓ Download PDF Eligibility for Institutional MA can be backdated up to three months before the month of application. In this case, the petitioner applied several times over many months and repeatedly failed to provide required verification by the deadline. Ultimately, […] Read more

DHA Case No. MGE 217517 (Wis. Div. Hearings and Appeals Jun. 12, 2025) (DHS) ↓ Download PDF An asset is unavailable if the member lacks the ability to provide legal access to the assets. In this case, the petitioner’s bank refused to give access to his guardian until the guardian was appointed representative payee by […] Read more

DHA Case No. MDV 216455 (Wis. Div. Hearings and Appeals June 6, 2025) (DHS) ↓ Download PDF An undue hardship waiver of a divestment penalty may be approved if the divested assets are not recoverable and the member would otherwise be deprived of necessary medical care, shelter, or other necessities. In this case, the petitioner’s […] Read more

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