DHA Case No. MGE 207353 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF A member’s patient liability can be reduced to allow payment of medical or remedial expenses that the member “has incurred, is actually paying, and is legally obligated to pay.” In this case, the petitioner verified that he […] Read more

DHA Case No. BCS 207395 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF A Notice of Proof Needed must advise the applicant of the specific verification required. In this case, the petitioner received a notice requesting proof of “TUITION: Amount of student loan or grant funds and how they are […] Read more

DHA Case No. BCS 207323 (Wis. Div. of Hearings and Appeals March 15, 2023) (DHS) ↓ Download PDF BadgerCare Plus benefits can be backdated up to three months if the petitioner meets all eligibility requirements in those months. In this case, the petitioner requested backdating but his tax documents did not list any business expenses, […] Read more

DHA Case No. MGE 207300 (Wis. Div. of Hearings and Appeals February 28, 2023) (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, the community spouse had earned […] Read more

DHA Case No. BCS 207290 (Wis. Div. of Hearings and Appeals February 10, 2023) (DHS) ↓ Download PDF An applicant must be a U.S. citizen or qualifying lawful immigrant to be eligible for Medicaid. In this case, the petitioner applied for MA and was initially approved, but Homeland Security soon notified the agency that the […] Read more

DHA Case No. MRA 207266 (Wis. Div. of Hearings and Appeals April 27, 2023) (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, ALJ Jason Grace increased the […] Read more

DHA Case No. MDV 207202 (Wis. Div. of Hearings and Appeals February 23, 2023) (DHS) ↓ Download PDF A transfer for less than fair market value is a divestment, and payments to relatives often also need a notarized contract or lease. In this case, the petitioner’s son and POA used the proceeds from selling her […] Read more

DHA Case No. MDD 207161 (Wis. Div. of Hearings and Appeals March 27, 2023) (DHS) ↓ Download PDF A disability determination for the MAPP does not involve the usual “substantial gainful activity” test, but that is only the first step in a 5-step analysis that often comes down to “residual functional capacity” to perform different […] Read more

DHA Case No. MAC 207150 (Wis. Div. of Hearings and Appeals January 31, 2023) (DHS) ↓ Download PDF To justify an Order to Compel Payment of Liability on appeal, the agency must at least show: (1) that it sent proper notice of the initial overpayment, (2) that it provided instructions for how to make payment […] Read more

DHA Case No. MPA 207141 (Wis. Div. of Hearings and Appeals February 24, 2023) (DHS) ↓ Download PDF To determine the number of personal care worker (PCW) hours it will approve, the Department uses the Personal Care Screening Tool, which can then be adjusted. In this case, the petitioner, an 81-year-old woman with a history […] Read more

DHA Case No. CWA 207110 (Wis. Div. of Hearings and Appeals March 29, 2023) (DHS) ↓ Download PDF The IRIS program can pay for equine therapy, according to the participant’s needs. In this case, the petitioner was approved for three months of twice-weekly equine therapy, which proved effective, but her subsequent request to continue the […] Read more

DHA Case No. CWA 207083 (Wis. Div. of Hearings and Appeals April 5, 2023) (DHS) ↓ Download PDF When the agency reduces supportive home care (SHC) hours and the member appeals, the burden of proof is on the agency to justify the reduction. In this case, the agency reduced SHC hours after a supplemental functional […] Read more

DHA Case No. BCS 207050 (Wis. Div. of Hearings and Appeals February 8, 2023) (DHS) ↓ Download PDF A Medicaid appeal must be filed within 45 days of a negative action. In this case, the petitioner’s mother contacted the agency in May 2020 to report getting a job and ask for her BadgerCare Plus benefits […] Read more

DHA Case No. CWK 206852 (Wis. Div. of Hearings and Appeals January 10, 2023) (DHS) ↓ Download PDF Vehicle modifications are allowed as a benefit of the Children’s Long-Term Support program, but they must “meet all applicable standards of manufacture, safety, design, and installation.” In this case, the petitioner’s mother asked for a modification to […] Read more