DHA Case No. CWK 216266 (Wis. Div. Hearings and Appeals Mar. 12, 2025) (DHS) ↓ Download PDF Achild in the Children’s Long-Term Support (CLTS) program must be recertified annually, including an updated functional screen. In this case, the petitioner was found functionally ineligible at her recertification, based on the criteria for the psychiatric hospital level […] Read more

DHA Case No. MRA 216768 (Wis. Div. Hearings and Appeals Mar. 6, 2025) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, a previous fair hearing decision had […] Read more

DHA Case No. CWK 216100 (Wis. Div. Hearings and Appeals Mar. 6, 2025) (DHS) ↓ Download PDF A child in the Children’s Long-Term Support (CLTS) program must be recertified annually, including an updated functional screen. In this case, the agency tried many times to schedule a home visit with the petitioner’s mother, but she repeatedly […] Read more

DHA Case No. MGE 216362 (Wis. Div. Hearings and Appeals Mar. 4, 2025) (DHS) ↓ Download PDF An individual is financially eligible for EBD Medicaid if the total value of all non-exempt liquid assets does not exceed $2,000 at the end of the month. In this case, the petitioner owned countable assets of $2,015.27 as […] Read more

DHA Case No. MGE 216346 (Wis. Div. Hearings and Appeals Feb. 28, 2025) (DHS) ↓ Download PDF An individual is financially eligible for EBD Medicaid if the total value of all non-exempt liquid assets does not exceed $2,000. In this case, the petitioner’s daughter and representative failed to complete a renewal and then, months later, […] Read more

DHA Case No. FCP 216638 (Wis. Div. Hearings and Appeals Feb. 20, 2025) (DHS) ↓ Download PDF Aperson is functionally eligible for Community Waivers long-term care programs if, among other criteria, the person cannot safely or appropriately perform 5 or more IADLs. In this case, the petitioner’s functional screen clearly indicated she needed help with […] Read more

DHA Case No. MAP 216504 (Wis. Div. Hearings and Appeals Feb. 19, 2025) (DHS) ↓ Download PDF To be eligible for MAPP, an individual must (1) be a disabled adult, (2) meet all nonfinancial Medicaid requirements, (3) satisfy the MAPP work requirement, unless exempt, and (4) pay any required premium payments, unless exempt. In this […] Read more

DHA Case No. CWA 216647 (Wis. Div. Hearings and Appeals Feb. 17, 2025) (DHS) ↓ Download PDF An IRIS participant may be disenrolled if the agency is unable to ensure the participant’s health and safety. In this case, the petitioner lived with her daughter, who was also her caregiver and guardian. The petitioner eloped from […] Read more

DHA Case No. CWA 216141 (Wis. Div. Hearings and Appeals Feb. 13, 2025) (DHS) ↓ Download PDF IRIS participants may be involuntarily disenrolled for failure to spend the funds in their budget. In this case, the petitioner was repeatedly warned that her failure to spend her IRIS budget could result in disenrollment, and she ultimately […] Read more

DHA Case No. CWA 216117 (Wis. Div. Hearings and Appeals Feb. 11, 2025) (DHS) ↓ Download PDF IRIS benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner’s renewal was due September 17 and partially submitted on September 18, but a required signature was not provided until October 10, resulting […] Read more

DHA Case No. CWK 215882 (Wis. Div. Hearings and Appeals Feb. 3, 2025) (DHS) ↓ Download PDF In the CLTS program, the County Waiver Agency plays a limited role in qualifying and authorizing participants’ chosen service providers, including checking certifications and licensure and conducting a background check. In this case, the county denied the petitioner’s […] Read more

DHA Case No. CWA 216047 (Wis. Div. Hearings and Appeals Feb. 3, 2025) (DHS) ↓ Download PDF IRIS benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner applied September 4 but did not complete verification until October 14, resulting in an enrollment date of November 1. Although the petitioner’s […] Read more

DHA Case No. CWA 215937 (Wis. Div. Hearings and Appeals Jan. 31, 2025) (DHS) ↓ Download PDF IRIS benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner applied August 27, verified assets on October 3, and finished verification with proof of medical premiums November 5. Although the petitioner’s guardian […] Read more

DHA Case No. MGE 215707 (Wis. Div. Hearings and Appeals Jan. 17, 2025) (DHS) ↓ Download PDF A person who has a cost share but fails to pay it is ineligible for Family Care. In this case, the petitioner lost eligibility for MAPP and thus had a cost share imposed. At the time of the […] Read more