DHA Case No. CWA 218226 (Wis. Div. Hearings and Appeals Oct. 30, 2025) (DHS) ↓ Download PDF Home modifications may be an allowable service covered by IRIS if they are needed, safe, and cost-effective. In this case, the petitioner needed a way to access the first floor of her home but could not safely use […] Read more

DHA Case No. MDV 218743 (Wis. Div. Hearings and Appeals Oct. 22, 2025) (DHS) ↓ Download PDF A refusal to claim property of a deceased spouse that a Medicaid applicant or member is entitled to is a divestment. In this case, the petitioner’s husband used nearly all the money in a joint revocable trust to […] Read more

DHA Case No. BCS 219604 (Wis. Div. Hearings and Appeals Sep. 29, 2025) (DHS) ↓ Download PDF In this case, the petitioners filed a Marketplace application for health insurance that erroneously omitted their income. They corrected this within an hour, but not before the system sent their no-income application to the consortium for BadgerCare Plus, […] Read more

DHA Case No. FCP 218386 (Wis. Div. Hearings and Appeals Sep. 23, 2025) (DHS) ↓ Download PDF When an agency error causes delay in an individual’s enrollment in an MCO, the Department may adjust the individual’s enrollment date. In this case, the petitioner switched from the IRIS program to the Family Care program with the […] Read more

DHA Case No. BCS 219279 (Wis. Div. Hearings and Appeals Sep. 15, 2025) (DHS) ↓ Download PDF A migrant worker can qualify for Emergency Services MA if he is currently working in Wisconsin and qualifies for BadgerCare Plus under a category other than childless adult. In this case, the petitioner was a migrant working in […] Read more

DHA Case No. FCP 218679 (Wis. Div. Hearings and Appeals Sep. 2, 2025) (DHS) ↓ Download PDF As stated in the recent DMS Ops Memo 25-07, the state must maintain Medicaid coverage while completing regularly scheduled renewals as long as the renewal is received before the end of the month the renewal is due. In […] Read more

DHA Case No. MGE 218412 (Wis. Div. Hearings and Appeals Aug. 25, 2025) (DHS) ↓ Download PDF If a married applicant’s spouse refuses to cooperate with signing the Medicaid application or providing information, the applicant can request an undue hardship waiver of the application denial. That undue hardship request must describe and document “all attempts […] Read more

DHA Case No. MGE 218539 (Wis. Div. Hearings and Appeals Aug. 20, 2025) (DHS) ↓ Download PDF It is well-settled precedent that beneficiaries must be given at least 10 days advance notice prior to an adverse action, such as a reduction or termination in benefits. In this case, the petitioner lost her eligibility for SSI […] Read more

DHA Case No. MGE 218599 (Wis. Div. Hearings and Appeals Aug. 15, 2025) (DHS) ↓ Download PDF An individual is financially eligible for EBD Medicaid if the total value of all countable and available resources does not exceed $2,000 at the end of the month in question. Income received that month and checks delivered but […] Read more

DHA Case No. MGE 218218 (Wis. Div. Hearings and Appeals Aug. 6, 2025) (DHS) ↓ Download PDF An ALJ can increase the Community Spouse Resource Allowance (CSRA) if the additional resources are needed to generate income for the community spouse up to the Minimum Monthly Maintenance Needs Allowance (MMMNA). In this case, the petitioner and […] Read more

DHA Case No. CWA 216468 (Wis. Div. Hearings and Appeals Aug. 4, 2025) (DHS) ↓ Download PDF Late renewals can cause a gap in Community Waivers enrollment, though the Department has allowed for an expedited re-enrollment process to minimize this. In this case, the petitioner completed a late renewal and would have used the expedited […] Read more

DHA Case No. MDV 217177 (Wis. Div. Hearings and Appeals Jul. 11, 2025) (DHS) ↓ Download PDF Medicaid fair hearing appeals must be filed within 45 days of the negative action. In this case, the incapacitated, nursing-home-bound petitioner—really, those acting on his behalf—went through a long period of multiple applications and denials. At first the […] Read more

DHA Case No. FCP 218663 (Wis. Div. Hearings and Appeals Jul. 24, 2025) (DHS) ↓ Download PDF As stated in the recent DMS Ops Memo 25-07, the state must maintain Medicaid coverage while completing regularly scheduled renewals as long as the renewal is received before the end of the month the renewal is due. In […] Read more

DHA Case No. CWA 217265 (Wis. Div. Hearings and Appeals Jul. 22, 2025) (DHS) ↓ Download PDF IRIS benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner admittedly failed to complete her renewal timely, resulting in a gap in benefits and needing to re-enroll with a new Fiscal Employer […] Read more