DHA Case No. MDV 143690 (Wis. Div. Hearings and Appeals Nov. 23, 2012) (DHS) ↓ Download PDF A divestment occurs when a Medicaid applicant transfers resources and receives less than fair market value in return; exempt business assets must be used in a business “for the self-support of the individual.” In this case, the petitioner […] Read more

DHA Case No. MED 36/91877 (Wis. Div. Hearings and Appeals Jun. 4, 2008) (DHS) ↓ Download PDF An institutionalized person’s home is exempt if the person expresses an intent to return there. In this case, the petitioner was admitted to a nursing home and a doctor opined that she “cannot realistically expect to return home,” […] Read more

DHA Case No. MDV 5/105182 (Wis. Div. Hearings and Appeals 2009) (DHS) ↓ Download PDF Agift that occurred during the lookback period and was made by either the institutionalized person or his or her spouse is a divestment. In this case, the petitioner’s husband amended their revocable trust to transfer their home to a new […] Read more

DHA Case No. MDV 59/60290 (Wis. Div. Hearings and Appeals Jan. 20, 2004) (DHS) ↓ Download PDF A gift that occurred during the lookback period and was made by either the institutionalized person or his or her spouse is a divestment. In this case, the petitioner’s husband disinherited her and then died a year before […] Read more

DHA Case No. FCP 220397 (Wis. Div. Hearings and Appeals Dec. 29, 2025) (DHS) ↓ Download PDF The Family Care program, through MCOs, must generally provide services that reasonably and effectively address all of the recipient’s long-term needs and outcomes, assist the recipient to be as self-reliant and autonomous as possible, and are cost effective. […] Read more

DHA Case No. MAP 219778 (Wis. Div. Hearings and Appeals Dec. 23, 2025) (DHS) ↓ Download PDF Medical Assistance policy requires applicants and recipients to verify self-employment income. In this case, the petitioner was enrolled in MAPP and a Medicare savings program when she applied for FoodShare and reported rental income from billboards she owned. […] Read more

DHA Case No. CWK 220665 (Wis. Div. Hearings and Appeals Dec. 22, 2025) (DHS) ↓ Download PDF Children may be functionally eligible for the CLTS program automatically if they meet certain age and diagnosis requirements. In this case, the petitioner was a five-year-old with autism whose was determined functionally ineligible after an updated functional screen. […] Read more

DHA Case No. MDD 219941 (Wis. Div. Hearings and Appeals Dec. 10, 2025) (DHS) ↓ Download PDF If the Social Security Administration finds that a person is not disabled for social security or SSI purposes, that decision is generally binding on any state agency making a medical assistance disability determination—but there is an exception if […] Read more

DHA Case No. CWA 219952 (Wis. Div. Hearings and Appeals Dec. 10, 2025) (DHS) ↓ Download PDF The Department may deny enrollment in the IRIS program for substantiated fraud during a previous enrollment, living in an ineligible residential setting, or inability or unwillingness to develop an Individual Support and Service Plan (ISSP) that ensures the […] Read more

DHA Case No. FCP 220016 (Wis. Div. Hearings and Appeals Dec. 8, 2025) (DHS) ↓ Download PDF Medicaid appeals must be filed within 45 days of the date of the notice of action. In this case, the petitioner was sent a cost share notice on April 11 but did not file an appeal until September […] Read more

DHA Case No. CWA 219262 (Wis. Div. Hearings and Appeals Dec. 29, 2025) (DHS) ↓ Download PDF IRIS enrollment and services generally require the participant to reside in a permanent living arrangement, though the participant can apply while in transitional housing and there is an exception for temporary absences up to 90 days. In this […] Read more

DHA Case No. CWK 219225 (Wis. Div. Hearings and Appeals Dec. 26, 2025) (DHS) ↓ Download PDF For the Children’s Community Options Program, the right to appeal is limited to the denial of eligibility for services, or a reduction or termination of services. In this case, the petitioner requested coverage of a safety wagon. ALJ […] Read more

DHA Case No. CWK 220287 (Wis. Div. Hearings and Appeals Dec. 16, 2025) (DHS) ↓ Download PDF To be covered by the CLTS program, a service dog must (a) do work or perform tasks for the benefit of a person with a disability, who (b) has a disability that substantially limits his/her ability to perform […] Read more

DHA Case No. MDV 220070 (Wis. Div. Hearings and Appeals Dec. 10, 2025) (DHS) ↓ Download PDF The action of avoiding the receipt of income that a Medicaid member is entitled to is a divestment. In this case, the petitioner revocably renounced a VA survivor’s pension, which was $948 normal pension and $567 Aid and […] Read more