DHA Case No. CWK 211734 (Wis. Div. of Hearings and Appeals April 26, 2024) (DHS) ↓ Download PDF To be eligible for the Children’s Long-Term Support program (CLTS), the child must meet an institutional level of care as determined by the program’s specific functional screen. In this case, the agency sought to disenroll the petitioner […] Read more

DHA Case No. FCP 211909 (Wis. Div. of Hearings and Appeals April 23, 2024) (DHS) ↓ Download PDF An individual is functionally eligible for Family Care 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 211595 (Wis. Div. of Hearings and Appeals March 22, 2024) (DHS) ↓ Download PDF The legal standards of functional eligibility for the Children’s Long-Term Support (CLTS) Waiver program and for the Katie Beckett program are identical. In this odd case, the petitioner was determined functionally ineligible for her CLTS renewal by […] Read more

DHA Case No. CWA 211775 (Wis. Div. of Hearings and Appeals March 5, 2024) (DHS) ↓ Download PDF To be functionally eligible for IRIS, a person must be unable to safely or appropriately perform some combination of activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The Department’s instructions for completing the […] Read more

DHA Case No. CWA 210975 (Wis. Div. of Hearings and Appeals January 24, 2024) (DHS) ↓ Download PDF One way to be functionally eligible for the IRIS program is to need help with one activity of daily living (ADL) and three instrumental activities of daily living (IADLs) and have a cognitive impairment. In this case, […] Read more

DHA Case No. FCP 211106 (Wis. Div. of Hearings and Appeals January 23, 2024) (DHS) ↓ Download PDF An individual is functionally eligible for Family Care if he or she needs a “nursing home” level of care, as determined by the functional screen—but occasionally the screening program is wrong. In this case, the petitioner used […] Read more

DHA Case No. FCP 209869 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF In general, the ADRC has 30 days from the date of request to determine functional eligibility or provide notice of a delay; IM has 30 days from the date of application to determine financial eligibility. In this […] Read more

DHA Case No. CWA 208719 (Wis. Div. of Hearings and Appeals October 23, 2023) (DHS) ↓ Download PDF An IRIS participant may be involuntarily disenrolled for loss of functional eligibility. In this case, the agency attempted to disenroll the petitioner from the IRIS self-directed personal care (SDPC) program only, not IRIS itself, for loss of functional […] Read more

DHA Case No. CWA 208939 (Wis. Div. of Hearings and Appeals August 21, 2023) (DHS) ↓ Download PDF When a person must use adaptive aids to perform an activity of daily living (ADL), this counts as needing assistance with the ADL for functional eligibility. In this case, the petitioner was disenrolled from IRIS after a […] Read more

DHA Case No. CWA 209455 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF An individual is functionally eligible for IRIS if he or she needs a “nursing home” level of care, as determined by the functional screen. In this case, the two most recent functional screens found the petitioner needed […] Read more

DHA Case No. FCP 206782 (Wis. Div. of Hearings and Appeals January 11, 2023) (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 needed help with one […] Read more

DHA Case No. FCP 189662 (Wis. Div. of Hearings and Appeals January 14, 2019) (DHS) ↓ Download PDF An individual is functionally eligible for Family Care if he or she needs a “nursing home” level of care, as determined by the functional screen. In this case, the petitioner was enrolled in Family Care and receiving […] Read more

DHA Case No. CWA 189325 (Wis. Div. of Hearings and Appeals January 8, 2019) (DHS) ↓ Download PDF When a person must use adaptive aids to perform an activity of daily living (ADL), this counts as needing assistance with the ADL for functional eligibility. In this case, the petitioner held onto the bed rail when […] Read more

DHA Case No. FCP 207851 (Wis. Div. of Hearings and Appeals August 31, 2023) (DHS) ↓ Download PDF An MCO must determine whether a requested service is medically necessary and cost-effective. But in this case, the petitioner’s mother and guardian refused to cooperate with the MCO’s attempts to get the information it needed to make […] Read more