DHA Case No. CWA 220910 (Wis. Div. Hearings and Appeals Mar. 25, 2026) (DHS) ↓ Download PDF An IRIS participant has a right to a fair hearing only after an adverse action, which is a denial, reduction, termination, or limitation of services or a denial of eligibility. In this case, the petitioner’s AFH received an […] Read more

DHA Case No. FCP 221947 (Wis. Div. Hearings and Appeals Mar. 24, 2026) (DHS) ↓ Download PDF The Family Care program provides residential services only if they are cost-effective or the member’s health and safety cannot be adequately safeguarded in their own home. In this case, the petitioner’s guardian requested he be placed in an […] Read more

DHA Case No. FCP 221463 (Wis. Div. Hearings and Appeals Mar. 24, 2026) (DHS) ↓ Download PDF The Program of All-Inclusive Care for the Elderly (PACE) may provide transportation services to maintain community connections and receive services in the community. In this case, the petitioner requested travel vouchers for the purpose of going to the […] Read more

DHA Case No. FCP 220772 (Wis. Div. Hearings and Appeals Mar. 20, 2026) (DHS) ↓ Download PDF In the Family Care program, MCOs may not deny a service that is reasonable and necessary to cost-effectively support the member’s long-term care outcomes. In this case, the petitioner’s Community Support Program services ended when the agency determined […] Read more

DHA Case No. FCP 221245 (Wis. Div. Hearings and Appeals Mar. 19, 2026) (DHS) ↓ Download PDF In the Family Care program, the MCO does not have to provide a service the participant wants if there are less expensive alternatives that achieve the same results. In this case, the MCO terminated the petitioner’s AFH funding […] Read more

DHA Case No. FCP 220220 (Wis. Div. Hearings and Appeals Mar. 19, 2026) (DHS) ↓ Download PDF An MCO may not deny a service that is reasonable and necessary to cost-effectively support a member’s long-term care outcomes. In this case, the petitioner had been living at home and receiving adult day care services. When she […] Read more

DHA Case No. CWA 221163 (Wis. Div. Hearings and Appeals Mar. 19, 2026) (DHS) ↓ Download PDF Services provided by IRIS must be cost-effective. In this case, the petitioner requested a budget amendment to pay for an increased hourly rate by the supported employment provider, whose rate had increased substantially over the past several years. […] Read more

DHA Case No. FCP 220856 (Wis. Div. Hearings and Appeals Mar. 9, 2026) (DHS) ↓ Download PDF All individuals, including family members, who provide paid care to Family Care participants must undergo a background check. In this case, the petitioner was enrolled in Family Care July 1, but his guardian and caregiver did not complete […] Read more

DHA Case No. CWA 220532 (Wis. Div. Hearings and Appeals Mar. 6, 2026) (DHS) ↓ Download PDF Personal care services must be provided consistent with a written physician’s order and according to state regulations. In this case, the petitioner’s plan of care, which was signed by a physician, ordered 47.5 hour per week for a […] Read more

DHA Case No. CWA 220664 (Wis. Div. Hearings and Appeals Mar. 4, 2026) (DHS) ↓ Download PDF After a service plan is implemented, IRIS consultant agencies (ICAs) must contact the participant monthly and meet in person at least every 90 days. Participants may be involuntarily disenrolled if the ICA is unable to reach the participant […] Read more

DHA Case No. CWA 221054 (Wis. Div. Hearings and Appeals Mar. 3, 2026) (DHS) ↓ Download PDF The IRIS program may include support broker services. A support broker “supports a participant in directing personal assistance services and services budgets” and “assists the participant in planning, securing, and directing self-supports” (essentially, helping a person maintain public […] Read more

DHA Case No. CWA 220503 (Wis. Div. Hearings and Appeals Mar. 9, 2026) (DHS) ↓ Download PDF Services provided through the IRIS program must generally be cost-effective and necessary to achieve a long-term care outcome. In this case, the petitioner had been receiving daily living skills training since 2019 but still required 24-hour support, and […] Read more

DHA Case No. FCP 220671 (Wis. Div. Hearings and Appeals Mar. 31, 2026) (DHS) ↓ Download PDF An individual’s functional eligibility for Family Care is determined by a functional screen, an interview that scores the person’s ability to perform tasks independently. In this case, the petitioner was determined functionally ineligible after a yearly renewal screen […] Read more

DHA Case No. FCP 221429 (Wis. Div. Hearings and Appeals Mar. 26, 2026) (DHS) ↓ Download PDF Community Waivers members in Group A have no cost share. In this case, the petitioner moved from Group A to Group B when she lost her eligibility for the Widow/Widower Group (a special status class of full-benefit Medicaid) […] Read more