DHA Case No. FCP 216785 (Wis. Div. Hearings and Appeals Apr. 14, 2025) (DHS) ↓ Download PDF To be functionally eligible for home and community based long term care services through the PACE program, an individual must require a “nursing home” level of care. In this case, the petitioner required assistance with one ADL and […] Read more

DHA Case No. FCP 216638 (Wis. Div. Hearings and Appeals Feb. 20, 2025) (DHS) ↓ Download PDF Aperson is functionally eligible for Community Waivers long-term care programs if, among other criteria, the person cannot safely or appropriately perform 5 or more IADLs. In this case, the petitioner’s functional screen clearly indicated she needed help with […] Read more

DHA Case No. CWA 215724 (Wis. Div. Hearings and Appeals Jan. 10, 2025) (DHS) ↓ Download PDF A person is functionally eligible for Community Waivers long-term care programs if, among other criteria, the person cannot safely or appropriately perform 5 or more IADLs or 4 IADLs and has a cognitive impairment. In this case, the […] Read more

DHA Case No. FCP 217860 (Wis. Div. Hearings and Appeals May 28, 2025) (DHS) ↓ Download PDF DHA decisions have recognized for nearly a decade that use of an adaptive aid is equivalent to requiring human assistance and counts as requiring assistance with the related ADL. In this case, the petitioner’s functional screen noted a […] Read more

DHA Case No. FCP 216239 (Wis. Div. Hearings and Appeals May 2, 2025) (DHS) ↓ Download PDF ADRCs and IM agencies must generally determine functional and financial eligibility as soon as practical and within 30 days, and Family Care benefits may be backdated if agency error causes a delay in enrollment. In this case, the […] Read more

DHA Case No. FCP 214983 (Wis. Div. Hearings and Appeals Jan. 24, 2025) (DHS) ↓ Download PDF ADRCs must determine functional eligibility as soon as practicable, and no later than 30 days after the request for a functional screen. Similarly, IM agencies must generally determine financial and non-financial eligibility within 30 days of the application. […] Read more

DHA Case No. FCP 215954 (Wis. Div. Hearings and Appeals Dec. 13, 2024) (DHS) ↓ Download PDF An individual is functionally eligible for Community Waivers programs if he or she needs a “nursing home” level of care, as determined by the functional screen. In this case, the petitioner’s functional screen found the petitioner functionally ineligible […] Read more

DHA Case No. CWK 212235 (Wis. Div. Hearings and Appeals May 17, 2024) (DHS) ↓ Download PDF To be functionally eligible for the CLTS program, a child must require an institutional level of care and be in a target group (intellectual/developmental disability, physical disability, or mental health disability). In this case, the agency found the […] Read more

DHA Case No. CWK 212281 (Wis. Div. Hearings and Appeals May 20, 2024) (DHS) ↓ Download PDF To be functionally eligible for the CLTS program, a child must require an institutional level of care and be in a target group (intellectual/developmental disability, physical disability, or mental health disability). In this case, the petitioner was found […] Read more

DHA Case No. FCP 211691 (Wis. Div. Hearings and Appeals Mar. 20, 2024) (DHS) ↓ Download PDF To be functionally eligible for Community Waivers long-term care programs, a person must fall into one of the target groups (frail elder, physical disability, or developmental disability) in addition to needing a nursing home level of care. In […] Read more

DHA Case No. CWA 211232 (Wis. Div. Hearings and Appeals Feb. 6, 2024) (DHS) ↓ Download PDF IRIS participants who fail to comply with program requirements or lose functional eligibility may be disenrolled. In this case, the petitioner needed to complete an annual long-term care functional screen but failed to respond to “multiple attempts” by […] Read more

DHA Case No. CWA 211033 (Wis. Div. Hearings and Appeals Feb. 6, 2024) (DHS) ↓ Download PDF To be functionally eligible for the IRIS program, a person must have a long-term care functional screen that determines them to need a “nursing home” level of assistance with activities of daily living (ADLs) and instrumental activities of […] Read more

DHA Case No. CWA 210988 (Wis. Div. Hearings and Appeals Feb. 5, 2024) (DHS) ↓ Download PDF IRIS participants who fail to comply with program requirements or lose functional eligibility may be disenrolled. In this case, the petitioner needed to complete an annual long-term care functional screen but failed to respond to twelve phone calls […] Read more

DHA Case No. FCP 210801 (Wis. Div. Hearings and Appeals Jan. 3, 2024) (DHS) ↓ Download PDF To be functionally eligible for Family Care, a person must fall into one of the program’s target groups in addition to needing a nursing home level of care. In this case, the petitioner was diagnosed with schizophrenia and […] Read more