DHA Case No. MDV 66/71952 (Wis. Div. Hearings and Appeals Jan. 25, 2006) (DHS) ↓ Download PDF A divestment penalty may be “cured” by returning the divested resource, or its equivalent value, to the individual. In this case, the petitioner made multiple divestments during the lookback period totaling more than $200,000, but her son paid […] Read more

DHA Case No. MDV 147776 (Wis. Div. Hearings and Appeals Jul. 12, 2013) (DHS) ↓ Download PDF The divestment penalty period for an Institutional MA applicant begins on the first date the person (1) is institutionalized, (2) has applied for Medicaid, and (3) is otherwise eligible for Medicaid. In this case, the petitioner applied on […] Read more

DHA Case No. MDV 146016 (Wis. Div. Hearings and Appeals Mar. 5, 2013) (DHS) ↓ Download PDF The divestment penalty period for a Family Care applicant begins on the first date the person (1) has applied for Family Care, (2) “meets the appropriate level of care and functional screen criteria,” and (3) meets all other […] Read more

DHA Case No. FCP 140118 (Wis. Div. Hearings and Appeals Jul. 13, 2012) (DHS) ↓ Download PDF Adivestment occurs when an institutionalized individual or spouse transfers assets for less than fair market value during the look-back period. In this case, the petitioner’s husband made cash withdrawals of $100,000 and $17,000 shortly before the application for […] Read more

DHA Case No. MDV 138459 (Wis. Div. Hearings and Appeals Apr. 24, 2012) (DHS) ↓ Download PDF A divestment occurs when an institutionalized individual transfers assets for less than fair market value during the look-back period. In this case, the petitioner’s bank statements showed withdrawals of $29,134.50 over two years. Her daughter and POA could […] Read more

DHA Case No. MDV 130600 (Wis. Div. Hearings and Appeals May 23, 2011) (DHS) ↓ Download PDF A transfer of income or resources for less than fair market value is a divestment and results in a penalty period, unless the transfer qualifies for an exception. One exception is if the applicant can show a pattern […] Read more

DHA Case No. FCP 217629 (Wis. Div. Hearings and Appeals May 5, 2025) (DHS) ↓ Download PDF When a Family Care member has a significant change in circumstances, the MCO must reassess the member’s care needs. In this case, the petitioner had multiple emergency room visits and was ultimately hospitalized, resulting in a reassessment and […] Read more

DHA Case No. MAP 217949 (Wis. Div. Hearings and Appeals May 13, 2025) (DHS) ↓ Download PDF To qualify as disabled for MAPP eligibility, a person must ultimately be unable to perform any substantial gainful activity. In this case, the petitioner was 28, had autism, anxiety disorder, and mild mental retardation, and had no physical […] Read more

DHA Case No. CWA 216742 (Wis. Div. Hearings and Appeals Aug. 4, 2025) (DHS) ↓ Download PDF Under the Wisconsin Equal Access to Justice Act (WEAJA), petitioners who prevail in a fair hearing are entitled to an award of costs unless the agency’s action was “substantially justified.” In this case, the petitioner successfully appealed the […] Read more

DHA Case No. MAP 216925 (Wis. Div. Hearings and Appeals Apr. 24, 2025) (DHS) ↓ Download PDF To be non-financially eligible for MAPP, a person must be working and meet the SSI standard for disability. In this case, the petitioner had laryngeal cancer and was initially determined disabled, but after a year and a half […] Read more

DHA Case No. MGE 217838 (Wis. Div. Hearings and Appeals Jul. 15, 2025) (DHS) ↓ Download PDF Court-ordered support payments are deducted from income for an “institutionalized person,” according to the Medicaid Eligibility Handbook (MEH). In this case, the petitioner paid $4,059 per month in court-ordered spousal support, had monthly income of $12,089.20 ($8,045.98 from a […] Read more

DHA Case No. MGE 216329 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF When an agency error causes a delay in an individual’s enrollment in Family Care, the enrollment date may be adjusted. In this case, the petitioner submitted his 183-page Medicaid application in three faxes on October 29 and received […] Read more

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