DHA Case No. FCP 211190 (Wis. Div. of Hearings and Appeals February 12, 2024) (DHS) ↓ Download PDF When applying for Family Care, Income Maintenance and the ADRC have 30 days to make their determinations of financial and functional eligibility. In this case, the petitioner was disenrolled November 1 due to excess assets, which her […] Read more

DHA Case No. FCP 210296 (Wis. Div. of Hearings and Appeals March 5, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the agency denied the application in August after erroneously counting a burial asset. In October, after the […] Read more

DHA Case No. CWA 209367 (Wis. Div. of Hearings and Appeals January 4, 2024) (DHS) ↓ Download PDF Community Waivers enrollment can be backdated if agency error causes unreasonable delay. In this complicated case, the petitioner was first enrolled in IRIS during the pandemic as a 17- or 18-year-old under his mother’s name. His mother […] Read more

DHA Case No. CWA 210997 (Wis. Div. of Hearings and Appeals January 17, 2024) (DHS) ↓ Download PDF It is the guardian’s responsibility to complete a Medicaid renewal and to keep DHS informed when circumstances change. In this case, the petitioner changed guardians but neither guardian informed the agency, which then sent the renewal notices […] Read more

DHA Case No. FCP 210973 (Wis. Div. of Hearings and Appeals January 16, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner’s authorized representative failed to complete his renewal: she “apparently left employment with her payee company, […] Read more

DHA Case No. FCP 209929 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the ADRC sent the Community Waivers referral to IM on June 16, but “for reasons unclear” IM […] Read more

DHA Case No. MGE 209925 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner was eligibile on July 6 but not enrolled until July 21 because the ADRC mistakenly […] 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. FCP 209037 (Wis. Div. of Hearings and Appeals November 14, 2023) (DHS) ↓ Download PDF The Department may backdate Family Care enrollment when there is an agency error that causes an unreasonable delay. In this case, the petitioner was found eligible in December of 2022 and the MCO received her enrollment form […] Read more

DHA Case No. FCP 208334 (Wis. Div. of Hearings and Appeals July 3, 2023) (DHS) ↓ Download PDF An ALJ may propose that Family Care enrollment be backdated only if the enrollment date was unnecessarily delayed by the ADRC or IM. In this case, the petitioner applied December 29, 2022 and the agency inaccurately processed […] Read more

DHA Case No. FCP 192893 (Wis. Div. of Hearings and Appeals November 5, 2019) (DHS) ↓ Download PDF An ALJ may issue a proposed decision asking the DHS Secretary to backdate enrollment in Family Care if the normal enrollment date was unnecessarily delayed by either the ADRC or Income Maintenance. In this case, both the […] Read more

DHA Case No. FCP 207387 (Wis. Div. of Hearings and Appeals March 30, 2023) (DHS) ↓ Download PDF An ALJ may issue a proposed decision asking the DHS Secretary to backdate enrollment in Family Care if the normal enrollment date was unnecessarily delayed by either the ADRC or Income Maintenance. In this case, both the […] Read more

DHA Case No. FCP 203910 (Wis. Div. of Hearings and Appeals March 23, 2023) (DHS) ↓ Download PDF If payments to a relative for services exceed 10% of the maximum CSAS, the MEH requires a notarized agreement. In this case, the petitioner had an agreement to pay her daughters $500 per month, but it was […] Read more

DHA Case No. FCP 207870 (Wis. Div. of Hearings and Appeals May 19, 2023) (DHS) ↓ Download PDF Family Care benefits generally cannot be backdated, except that retroactive enrollment can be ordered by an ALJ to correct delay caused by agency error. In this case, the petitioner applied January 25, the application was processed February […] Read more