DHA Case No. CWA 219262 (Wis. Div. Hearings and Appeals Dec. 29, 2025) (DHS) ↓ Download PDF IRIS enrollment and services generally require the participant to reside in a permanent living arrangement, though the participant can apply while in transitional housing and there is an exception for temporary absences up to 90 days. In this […] Read more

DHA Case No. CWA 220073 (Wis. Div. Hearings and Appeals Dec. 5, 2025) (DHS) ↓ Download PDF When the IRIS program ends a participant’s enrollment involuntarily, it bears the burden of proof to show that the disenrollment was proper. In this case, the IRIS Consultant (IC) submitted only an unsigned, unsworn written statement about an […] Read more

DHA Case No. CWA 219687 (Wis. Div. Hearings and Appeals Nov. 13, 2025) (DHS) ↓ Download PDF While ADRCs do not have primary responsibility for assisting people with Medicaid applications, they are contracted to provide general assistance, including assistance with obtaining verification. In this case, the ADRC faxed verification documents for the petitioner to Income […] Read more

DHA Case No. CWA 219315 (Wis. Div. Hearings and Appeals Oct. 9, 2025) (DHS) ↓ Download PDF The IRIS program must generally cover services that are needed and cost-effective. In this case, the petitioner had severe violent behavior that culminated in felony charges after attacking a staff member. After that, only one AFH was both […] Read more

DHA Case No. CWA 219173 (Wis. Div. Hearings and Appeals Oct. 1, 2025) (DHS) ↓ Download PDF When a person’s eligibility for SSI ends, agency policy is to automatically run Medicaid eligibility under other criteria. In this case, the petitioner’s SSI ended and she even received a notice saying she didn’t need to do anything […] 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. CWA 219333 (Wis. Div. Hearings and Appeals Oct. 15, 2025) (DHS) ↓ Download PDF Aperson enrolled in IRIS is required to pay a cost share as a condition of eligibility. In this case, the petitioner had more than $4,000 in overdue cost share and had previously entered a repayment agreement, but failed […] Read more

DHA Case No. CWA 219663 (Wis. Div. Hearings and Appeals Oct. 13, 2025) (DHS) ↓ Download PDF An IRIS participant may be involuntarily disenrolled if the program cannot ensure the participant’s health and safety. In this case, the petitioner had 25 critical incidents (a critical incident is a medical emergency, law enforcement contact, or hospitalization) […] Read more

DHA Case No. MGE 219014 (Wis. Div. Hearings and Appeals Oct. 6, 2025) (DHS) ↓ Download PDF IRIS enrollment dates may be revised if the agency is the cause of a wrongful termination of IRIS enrollment. In this case, the agency sent advance notice of the renewal deadline and a notice requiring verification of a […] Read more

DHA Case No. CWA 219176 (Wis. Div. Hearings and Appeals Oct. 1, 2025) (DHS) ↓ Download PDF IRIS enrollment dates may be revised if the agency is the cause of a wrongful termination of IRIS enrollment. In this case, the agency called the petitioner before her renewal deadline but she declined to do the renewal […] Read more

DHA Case No. CWA 218110 (Wis. Div. Hearings and Appeals Sep. 25, 2025) (DHS) ↓ Download PDF IRIS participants may submit one-time expense requests to pay for goods or services, including adaptive aids such as vehicle modifications. In this case, the petitioner requested a wheelchair and hand-controls conversion after her old vehicle, which had been […] Read more

DHA Case No. CWA 218862 (Wis. Div. Hearings and Appeals Sep. 19, 2025) (DHS) ↓ Download PDF IRIS participants may be disenrolled if they cannot or will not address health and safety concerns. In this case, the petitioner lived with his parents/guardians who themselves were aging and having health problems that were impeding their ability […] Read more

DHA Case No. CWA 218438 (Wis. Div. Hearings and Appeals Sep. 18, 2025) (DHS) ↓ Download PDF Prevocational services may be funded through IRIS, but services in sheltered workshop settings are excluded and the participant must have a goal of community-integrated employment. In this case, the petitioner received prevocational services for 11 years in a […] Read more

DHA Case No. CWA 219278 (Wis. Div. Hearings and Appeals Sep. 11, 2025) (DHS) ↓ Download PDF Any negative action regarding a person enrolled in Medicaid must be preceded by proper notice. In this case, the petitioner lost her SSI eligibility but the agency never sent a notice before terminating her from IRIS. ALJ Brian […] Read more