DHA Case No. BCS 215656 (Wis. Div. Hearings and Appeals Dec. 27, 2024) (DHS) ↓ Download PDF A notice requesting verification must be in writing, specific as to the verification required, and allow a minimum of 20 days to provide it. A notice of adverse action must be mailed at least 10 calendar days before […] Read more

DHA Case No. BCS 215161 (Wis. Div. Hearings and Appeals Dec. 18, 2024) (DHS) ↓ Download PDF To be eligible for BadgerCare Plus, a person must meet certain financial and non-financial requirements, including verification of income for self-employment. In this case, the petitioner verified her self-employment income with a partial, unsigned copy of her tax […] Read more

DHA Case No. BCS 211404 (Wis. Div. Hearings and Appeals Feb. 8, 2024) (DHS) ↓ Download PDF BadgerCare Plus counts all available income, even if the member chooses not to receive it. In this case, the petitioner chose to stop receiving long-term disability benefits of nearly $2,000 per month in an attempt to maintain her […] Read more

DHA Case No. BCS 213610 (Wis. Div. Hearings and Appeals Sep. 23, 2024) (DHS) ↓ Download PDF To determine self-employment income, Wisconsin Medicaid programs generally use the previous year’s federal tax return; but if the business had a “significant change in circumstances,” the agency must use anticipated earnings instead. In this case, the petitioner was […] Read more

DHA Case No. BCS 213015 (Wis. Div. of Hearings and Appeals June 24, 2024) (DHS) ↓ Download PDF During the Covid public health emergency unwinding, members who had an increase in earned income could qualify for a 12-month extension starting the month after their renewal. In this case, the petitioner qualified for an extension but […] Read more

DHA Case No. BCS 212166 (Wis. Div. of Hearings and Appeals May 10, 2024) (DHS) ↓ Download PDF The county agency must give individuals adequate written notice of verification requests. In this case, the agency sought to verify whether the petitioner was residing with her estranged spouse. The notice, however, only requested verification of “people […] Read more

DHA Case No. BCS 211320 (Wis. Div. of Hearings and Appeals January 18, 2024) (DHS) ↓ Download PDF To be eligible for Medicaid, an applicant must verify his or her income. In this case, the petitioner tried to fax the verification from a public library to two different fax numbers, but the agency never received […] Read more

DHA Case No. BCS 210387 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF In general, BadgerCare Plus counts all taxable income. However, the IRS allows some live-in care providers to list all payments as a business expense; in those circumstances, BadgerCare Plus also does not count these payments as income. […] Read more

DHA Case No. BCS 210493 (Wis. Div. of Hearings and Appeals January 9, 2024) (DHS) ↓ Download PDF BadgerCare Plus eligibility is based on income and, unlike EBD Medicaid programs, taxable withdrawals from IRAs are counted as income. In this case, the petitioner was 63 and his only income was monthly withdrawals of $3,200 from […] Read more

DHA Case No. HMO 210862 (Wis. Div. of Hearings and Appeals January 10, 2024) (DHS) ↓ Download PDF Although orthodontia is not usually covered by MA, it must be covered for recipients under age 21 if the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) health assessment and evaluation indicates that it is medically necessary. […] Read more

DHA Case No. MOP 190168 (Wis. Div. of Hearings and Appeals January 11, 2019) (DHS) ↓ Download PDF When a Medicaid recipient fails to report a change in income or assets that would affect eligibility, an overpayment results. In this case, the petitioner was a 92-year-old woman receiving community waivers and healthcare benefits, and it […] Read more

DHA Case No. MTI 208493 (Wis. Div. of Hearings and Appeals July 14, 2023) (DHS) ↓ Download PDF To be recoverable, an overpayment must be caused by the recipient’s error—overpayments caused by agency error are not recoverable. In this case, the petitioner misread a notice of FoodShare benefits ending, believing all her benefits were ending. In fact, […] Read more

DHA Case No. BCS 207937 (Wis. Div. of Hearings and Appeals June 6, 2023) (DHS) ↓ Download PDF An applicant for BadgerCare Plus must provide his or her Social Security number. In this case, the petitioner applied but failed to provide it. The agency properly issued the request for proof and mailed it to the […] Read more

DHA Case No. BCS 207099 (Wis. Div. of Hearings and Appeals February 20, 2023) (DHS) ↓ Download PDF Countable self-employment income is generally reduced by business expenses, but “principal payments on loans for the purchase price of income-producing real estate, capital assets and equipment, and durable goods” are not allowed expenses for BadgerCare Plus and Medicaid. In […] Read more