DHA Case No. MGE 216221 (Wis. Div. Hearings and Appeals May 2, 2025) (DHS) ↓ Download PDF Re-enrollment in IRIS can be expedited if a renewal is completed late but within 30 days of disenrollment. In this case, the petitioner was disenrolled October 1 but ready to re-enroll October 7. But because his old fiscal […] 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. CWA 215905 (Wis. Div. Hearings and Appeals Apr. 11, 2025) (DHS) ↓ Download PDF IRIS enrollment and benefits may be backdated if agency error caused unreasonable delay. In this case, the petitioner’s renewal processing was delayed more than a month when a lead worker mistakenly required Letters of the Estate for a […] Read more

DHA Case No. FCP 215775 (Wis. Div. Hearings and Appeals May 2, 2025) (DHS) ↓ Download PDF Family Care benefits may be backdated if agency error causes a delay in enrollment. In this case, the petitioner resided in a CBRF that Income Maintenance misidentified as a nursing home. She applied August 22, the ADRC sent […] Read more

DHA Case No. MGE 215665 (Wis. Div. Hearings and Appeals Mar. 20, 2025) (DHS) ↓ Download PDF In general, agencies must process Medicaid applications within 30 days, allow at least 20 days for additional verifications, and may not request excessive or unnecessary verification. In this case, the petitioner applied for Family Care on July 16. […] 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. MGE 214557 (Wis. Div. Hearings and Appeals Jan. 15, 2025) (DHS) ↓ Download PDF Medicaid participants are entitled to proper notice before disenrollment. In this case, the petitioner’s deadline to provide verification for a renewal was March 28, 2024. Her authorized representative tried to call IM twice that day but did not […] Read more

DHA Case No. CWA 212475 (Wis. Div. Hearings and Appeals Jan. 15, 2025) (DHS) ↓ Download PDF For Community Waivers benefits to be backdated, a delay in enrollment must be caused by agency error. In this case, the petitioner argued notices regarding her renewal were defective for various reasons, making some creative arguments. She also […] Read more

DHA Case No. FCP 215902 (Wis. Div. Hearings and Appeals Feb. 19, 2025) (DHS) ↓ Download PDF An irrevocable burial trust (as opposed to a life insurance-funded burial contract) is exempt up to $4,500; any amount over that is countable. In this case, the petitioner was disenrolled from Family Care due to his $8,800 irrevocable […] Read more

DHA Case No. MGE 215845 (Wis. Div. Hearings and Appeals Feb. 17, 2025) (DHS) ↓ Download PDF Medicaid denials must be appealed within 45 days. In this case, the petitioner received notices dated April 18, 2023 and August 29, 2023 determining that she was over the asset limit in April, May, and June. But because […] Read more

DHA Case No. FCP 167655 (Wis. Div. Hearings and Appeals Mar. 21, 2016) (DHS) ↓ Download PDF In general, Family Care benefits do not begin until an applicant is determined eligible and signs an enrollment form. In this seminal case, the petitioner applied April 20, signed an enrollment form May 13 (with the date of […] Read more

DHA Case No. MGE 214870 (Wis. Div. Hearings and Appeals Nov. 19, 2024) (DHS) ↓ Download PDF One exception to the usual divestment rule is if the individual intended to dispose of the resource at fair market value. In this case, the petitioner’s husband had “invested” $275,000 in an online scam, for which the county […] Read more

DHA Case No. FCP 213736 (Wis. Div. Hearings and Appeals Aug. 28, 2024) (DHS) ↓ Download PDF A participant in Family Care can be involuntarily disenrolled if they are determined ineligible for MA. In this case, the petitioner submitted his renewal timely and was eligible, but his MCO disenrolled him in error and could not […] Read more

DHA Case No. FCP 213852 (Wis. Div. Hearings and Appeals Sep. 12, 2024) (DHS) ↓ Download PDF Family Care enrollment may only be backdated when the agency has caused a delay after the application date. In this case, the petitioner mistakenly applied for Institutional MA in March and was found eligible before discovering that she […] Read more